Pediatric Mediastinal Compression Syndrome
Introduction
Introduction to pediatric mediastinal compression syndrome Mediastinumstressed syndrome (mediastinumstressed syndrome) is a group of syndromes. Any lesions in any tissue or organ in the mediastinum can cause compression symptoms in the respiratory tract, cardiovascular and esophagus. The cause can be congenital tissue abnormalities or primary. Or metastatic tumors, but also caused by lymphadenitis and abscesses, due to different compression sites and properties, their performance is also inconsistent. basic knowledge Sickness ratio: 0.0001% Susceptible people: children Mode of infection: non-infectious Complications: shock ascites
Cause
Causes of pediatric mediastinal compression syndrome
(1) Causes of the disease
This syndrome can be caused by thymus, lymph node lesions, tumors, bronchial cysts, mediastinal inflammation, abscesses or repeated malformations of the digestive tract.
(two) pathogenesis
Anterior mediastinal lesion
There are thymic lesions, teratoma, malignant lymphoma and ductal tumors.
(1) Thymic lesions: Infants often see thymic hypertrophy or hyperplasia, the former is asymptomatic, gradually shrinks with age, often disappears within 1 year. There is also a slow increase in asymmetry, or at the bottom of the mediastinum. On the X-ray film, thymic hyperplasia and tumor are difficult to identify. If prednisone is given 2mg/(kg·d), after 5 days, the film disappears. Benign thymus enlargement may occur again after several weeks of withdrawal. If it persists, thymus biopsy should be performed. This method can prevent one operation for children under 18 months of age, but it should not be used for respiratory compression or age. Larger children, because lymphoma can also occur in the thymus, it is difficult to identify at this time, can also be mediastinal gas angiography or tomography, which is helpful for diagnosis.
(2) malignant lymphoma: the mediastinum is a predilection site of lymphoma. The characteristic features of X-ray films are that the mass is lobulated, its boundary is unclear, its shape is large, and it is often associated with the innominate artery or vena cava. If a biopsy is performed, even a large amount of bleeding can be caused. Excessive lymphoma can cause fatal respiratory distress.
2. Mediastinal lesions
More common in lymph node lesions and bronchial cysts caused by compression.
(1) bronchogenic cysts: mostly benign diseases, accounting for about 1/3 of mediastinal tumors, due to abnormal bronchial dysplasia during embryonic period, moving in the mediastinum, with 1 to 5 mm thin-walled cyst, often attached to the trachea Or the bronchial wall, close to the tracheal bifurcation, the cystic cavity and the bronchus are not connected, the cyst wall and the bronchial wall structure are the same, the inner wall of the cavity is composed of columnar epithelial cells, generally the cyst is single-atrial, with a diaphragm and mucus-like liquid inside, clinical Asymptomatic often found in health checkups, such as cyst infection, can break into the bronchi, produce secondary infections, often fever, cough, cough, shortness of breath and other symptoms, when the cyst is located behind the trachea or bronchi, between the trachea Between the esophagus and the esophagus, the size of the cyst can cause the trachea, bronchial and esophagus to have different degrees of compression symptoms. In severe cases, there is a feeling of pharyngeal obstruction, difficulty in breathing, occasional bronchial cysts and bronchial communication, and a fluid level can be seen in the sac.
(2) lymphadenopathy: most of the mediastinal lymph nodes are located in the upper, middle and mediastinum, close to the trachea and its branches, may be caused by tuberculosis, fungi or sarcoidosis, in childhood tuberculosis and histoplasmosis infection, more With obvious pulmonary symptoms, but mainly lymphadenopathy, skin test can help the diagnosis of the former, if the reaction is negative, it can take a biopsy of the scalene lymph node or mediastinal lymph node mass, the compression symptoms caused by mediastinal lymphadenopathy Lymphoma is the most common.
3. Posterior mediastinal lesion
Neurogenic tumors and digestive tract repetitive are the most common posterior mediastinal lesions in childhood. Acute mediastinal inflammation and mediastinal abscess are caused by anterior and posterior mediastinal infections.
(1) Neurogenic tumor: a common mediastinal mass in children, it has been reported that this disease accounts for 32.6% of mediastinal tumors.
(2) digestive tract repetition: in all the digestive tract repeats in the mediastinum, the esophageal duplication cyst is about 10% to 15%, located between the muscular layers of the lower esophagus, occasionally communicating with the esophageal lumen, huge cysts can cause breathing Embarrassed.
(3) acute mediastinal inflammation and mediastinal abscess: most of the anterior mediastinal abscess spread by the neck infection, and most of the posterior mediastinal abscess is caused by perforation of the esophagus, both of which can cause lymphadenopathy and purulence due to pulmonary infection, so that the mediastinum is compressed ( Upper vena cava syndrome), due to different parts of the abscess, its symptoms and signs are also different, generally have chills, high fever, post-sternal pain, difficulty in swallowing and systemic poisoning, acute suppurative mediastinal inflammation can be serious Symptoms of venom, tuberculous mediastinal abscess sometimes difficult to distinguish from tumor.
Prevention
Prevention of pediatric mediastinal compression syndrome
Actively prevent tuberculosis infection, vaccinate all kinds of vaccines on time; actively prevent the occurrence of tumors. Prevent various congenital malformations.
Complication
Complications of pediatric mediastinal compression syndrome Complications shock ascites
Depending on the primary disease, such as cysts can be secondary infection, inflammation can cause severe toxic symptoms, because of compression can cause Horner syndrome, cardiac insufficiency or congestion symptoms, chest tube compression can cause chylothorax effusion or Ascites and so on.
1. Toxemia (toxaemia) refers to the bacterial toxin from the local infection of the lesion into the blood circulation, resulting in systemic sustained high fever, accompanied by a lot of sweating, pulse weak or shock.
2.Horner syndrome is a group of sympathetic paralysis syndrome characterized by retraction of the eyeball, dilated pupils, ptosis, vasodilation and no sweat in the face and neck.
3. There is a potential cavity between the visceral and parietal layers of the pleura, called the pleural cavity. Under normal circumstances, the width of the pleural cavity between the two layers of pleural cavity is about 10 ~ 20m, containing the slurry, about 0.1 ~ 0.2ml per kilogram of body weight, usually colorless, transparent, lubrication pleura, its exudation and resorption In equilibrium, any factor causes an increase in exudation and/or a decrease in reabsorption, ie, accumulation of fluid in the pleural cavity, resulting in pleural effusion.
4. Under normal conditions, there is a small amount of liquid (usually less than 200ml) in the abdominal cavity of the human body, which will lubricate the intestinal peristalsis. Any pathological condition leads to an increase in the amount of fluid in the abdominal cavity. When it exceeds 200 ml, it is called ascites.
Symptom
Symptoms of mediastinal compression syndrome in children Common symptoms Chest pain, difficulty swallowing, mechanical compression, chest water, chest tightness, ascites, congestion, paralysis, cyst
Symptoms are related to the size, location, growth rate and pressure of the tumor, and invasion of adjacent tissues and organs. Although the benign mass has grown greatly, it can be clinically free of any symptoms, only found in fluoroscopy, asymptomatic mediastinum. Among tumors, neurogenic mediastinal tumors accounted for the largest proportion.
Severe symptoms of respiratory compression, more common in high-grade mediastinal tumors, may have chest tightness, chest pain, the degree is not very serious, because the organs in the mediastinum are closely arranged, there is no gap, so regardless of the size of the tumor, can be squeezed Different degrees of compression symptoms occur in adjacent tissues and pleura.
When the stellate ganglion or the cervical sympathetic nerve, the intercostal nerve and the wall are compressed, it can cause Horner syndrome. When the phrenic nerve is compressed, the transverse movement is abnormal under fluoroscopy. Under normal circumstances, when inhaling , , , , , , , , , , , ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;
Due to the compression of the aorta and its branches, the pulsation of the carotid artery and the radial artery may be disproportionate. For example, the heart, inferior vena cava or pulmonary artery may be compressed, which may cause cardiac insufficiency or congestion symptoms; esophageal compression may cause difficulty in swallowing and pharynx Pain, chest tube compression, can cause chylothorax or ascites, if the teratoma is penetrated into the bronchus, cough up hair or sebum-like substances, thymus mass sometimes develops symptoms of myasthenia gravis, and deep sputum reflex increases in children The leg is weak. If the chest radiograph has a mediastinal mass, it indicates that the tumor has extended to the spinal canal. If there is a Horner syndrome, it indicates that the sympathetic nerve is involved. The thymus cyst sometimes touches the capsular bag on the collarbone. Piece.
Examine
Examination of pediatric mediastinal compression syndrome
There were white blood cell counts and significant increases in neutrophils in the presence of infected peripheral blood. For tuberculous lymphadenopathy, the erythrocyte sedimentation rate increased significantly. Malignant tumors often have anemia and other manifestations.
Chest X-ray, chest lateral radiograph and X-ray special examination, including selective tomography, CT scan, cardiovascular angiography, cardiovascular wave radiography, myelography, etc., when esophagus, tracheal involvement When pressing, a tracheal or esophagoscopy or contrast examination, radionuclide tracer examination is needed to determine the location and extent of compression.
Diagnosis
Diagnosis and diagnosis of mediastinal compression syndrome in children
For those suspected of echinococcosis or ooplasmosis, skin sensitivity test and serum complement test should be done. In addition, ultrasound, vanillyl mandelic acid (VMA) determination and bone marrow cell examination and culture can be performed. If diagnosed, cervical lymph nodes, especially the scalene lymph nodes, should be examined.
Mainly rely on X-ray examination and mediastinal lymph node biopsy to confirm the diagnosis, the signs can be used as a reference.
After the diagnosis of mediastinal compression syndrome, the differential diagnosis of the cause and the differential diagnosis of the location of the lesion and the nature of the lesion should be made.
