5．縦隔腫瘍

Emergency Surgical Management of Mediastinal Tumors

縦隔腫瘍に起因して緊急手術が必要になる病態はまれである．しかし急性の症状やその重篤性から，限られた時間で臨床判断を迫られることが多い．また，非典型的な画像所見から，正確な診断にたどり着くことが困難なことも推測される．事前に特殊な病態として学んでおくことが臨床決断の一助になるであろう．

Mediastinal tumors rarely lead to acute symptomatic manifestations due to spontaneous rupture and perforation, intra-tumoral hemorrhage, and bacterial contamination. Moreover, giant mediastinal tumors can compress and infiltrate surrounding mediastinal structures, such as the trachea, bronchus, cardiac sac, and superior vena cava, at the first visit. In addition, mediastinal mature teratomas include various ectopic tissues such as digestive glands and sebaceous glands that can cause specific pathological conditions. To address and properly manage patients with these rare conditions, prior learning must be emphasized to facilitate in clinical decision-making. In this article, we classified four pathological conditions of emergency due to mediastinal tumors. These include the clinical conditions resulting from the compression of anatomical structures by the tumor, those resulting from infiltration and extension into the surrounding mediastinal structures by the tumor, the specific conditions attributable to mature teratomas, and the occurrence of hemothorax due to spontaneous rupturing of the tumor. Based on the review of our cases and other recently reported cases, we summarize and discuss practical pitfalls and pearls in the emergency surgical management of these rare but life-threatening clinical situations.