Congenital anterior mediastinal teratoma causing severe airway compression in a neonate.

To cite: Bekker A, Goussard P, Gie R, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-201205 DESCRIPTION A newborn, weighing 2200 g, was delivered through caesarean section, at 35 weeks gestational age, for fetal distress. No antenatal scan had been performed. The neonate presented with severe respiratory distress shortly after birth and requiring urgent intubation. The chest X-ray (figure 1A) revealed a wide mediastinum with poor visualisation of the trachea. A tracheobronchogram, using water-soluble contrast medium (figure 1B), performed in the neonatal intensive care unit demonstrated severe narrowing of the trachea from tracheal midpoint up to and including the carina and origins of both main bronchi. The echocardiography confirmed a structurally normal heart. In addition a cystic fluid filled mass in the anteriorsuperior mediastinum was visualised. At flexible bronchoscopy anterior compression of the trachea with no structural tracheal stenosis was demonstrated. The chest CT (figure 2) confirmed a large, predominately low-density, non-enhancing, heterogeneous mass in the anterior mediastinum with posterior displacement and critical circumferential narrowing of the trachea. A congenital teratoma was suspected and complete surgical excision of the mass (60×40×22 mm) was performed on day 5 of life. Histology confirmed a benign grade 1 immature teratoma originating from the thymus. The neonate was successfully extubated 9 days postoperatively and made an uneventful recovery. At follow-up the infant remained asymptomatic. Fetal mediastinal teratomas represent only 10% of congenital teratomas. Congenital mediastinal teratomas are rare congenital abnormalities. These lesions can present with unmanageable airway compression and acute cardiorespiratory failure. Treatment requires immediate recognition and complete surgical excision of the lesion. α-Fetoprotein blood levels can be used to monitor the presence of tumour cells. Before and after surgery these values were 60 390.8 and 9361.7 mg/L, respectively in our patient.