The successful removal of an anterior mediastinal teratoma from an infant.

The patient was a baby girl aged 8 days. Pregnancy had been normal and she was delivered at full term. As the mother had previously had a pelvic floor repair, delivery was by Caesarean section. The child was limp at birth, but responded slowly to lobeline and oxygen. The following day it was noticed that she became severely cyanosed after every breast feed and that the cyanosis was only slowly relieved by oxygen. Examination showed her to be a healthy looking infant weighing 7 lb. 13 oz. No external abnormalities could be detected, but there was some indrawing of the lower intercostal spaces with respiration. Percussion ot the chest revealed generaiizea auiiness and there was FIG. 1.-Antero-posterior radiograph of chest showing la poor air intake. There were no other abnormal physical sided mediastinal mass. findings. A radiograph of the chest on the eighth day showed a large intrathoracic opacity filling most of the right hemithorax. The heart was markedly displaced to the left (Fig. 1). A right lateral radiograph showed that this opacity was situated almost entirely in the anterior mediastinum (Fig. 2). There were irregular areas of calcification in the anterior portion of the opacity. From the findings a diagnosis of anterior mediastinal teratoma was made. During the next two days the cyanotic attacks following feeds became worse and it was decided to try and remove the tumour. The operation was carried out when the patient was 10 days old by Mr. Gordon Cruickshank. Before operation a blood transfusion was started. Anaesthesia was induced with oxygen and cyclopropane. The fifth rib was resected through a right subscapular incision. A tumour was visible immediately the pleura was opened. It occupied nearly the entire hemithorax, and was partly solid, nartlv cvstict. Fluid wasie nenirated frnm the nuetri nart* to d..im s i . ts-bulk,.af.te wh.ich-theme aIG. 2.-Rlert lateral raitograpn of chest. Note areast to diminish itS bulk, after which the mediastinal pleura cation in the anterior part of the tumour. arge right-