Koo Zhao Peng, Chainchel Singh Mansharan Kaur, Mohamad Noor Mohamad Helmee Bin, Omar Norhayati Binti, Siew Sheue Feng
Department of Forensic Pathology, University of Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia.
National Institute of Forensic Medicine, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia.
Forensic Sci Med Pathol. 2024 Mar;20(1):226-232. doi: 10.1007/s12024-023-00669-4. Epub 2023 Jul 12.
We report a fatal case of a 26-year-old nulliparous woman who presented with an anterior mediastinal mass in her late pregnancy. She had complained of a progressively increasing neck swelling and occasional dry cough in the early second trimester, which was associated with worsening dyspnoea, reduced effort tolerance and orthopnoea. Ultrasound of the neck showed an enlarged lymph node, and chest X-ray revealed mediastinal widening. At 35 weeks' gestation, the patient was referred to a tertiary centre for a computed tomography (CT) scan of the neck and thorax under elective intubation via awake fibreoptic nasal intubation as she was unable to lie flat. However, she developed sudden bradycardia, hypotension and desaturation soon after being positioned supine, which required resuscitation. She succumbed after 3 days in the intensive care unit. An autopsy revealed a large anterior mediastinal mass extending to the right supraclavicular region, displacing the heart and lungs, encircling the superior vena cava and right internal jugular vein with tumour thrombus extending into the right atrium. Histopathology examination of the mediastinal mass confirmed the diagnosis of a primary mediastinal large B-cell lymphoma. This report emphasizes the severe and fatal outcome resulting from the delay and misinterpretation of symptoms related to a mediastinal mass.
我们报告一例26岁未育女性的致命病例，该患者在妊娠晚期出现前纵隔肿块。她在孕中期早期就抱怨颈部肿胀逐渐加重，偶尔干咳，伴有呼吸困难加重、活动耐力下降和端坐呼吸。颈部超声显示一个肿大的淋巴结，胸部X线显示纵隔增宽。妊娠35周时，由于患者无法平卧，通过清醒纤维鼻插管在择期插管下被转诊至三级中心进行颈部和胸部的计算机断层扫描（CT）。然而，她在仰卧位后不久出现突然的心动过缓、低血压和血氧饱和度下降，需要进行复苏。她在重症监护病房3天后死亡。尸检发现一个巨大的前纵隔肿块延伸至右锁骨上区域，推移心脏和肺部，环绕上腔静脉和右颈内静脉，肿瘤血栓延伸至右心房。纵隔肿块的组织病理学检查确诊为原发性纵隔大B细胞淋巴瘤。本报告强调了纵隔肿块相关症状的延误和误诊所导致的严重致命后果。
