Critical Case: Child Saved from Rare Chest Mass and Respiratory Distress - Dr Rasikal Shah

Mumbai: What began as gradual neck stiffness and mild breathing difficulty turned into a life-threatening condition for two-year-old Abigail Lobo, whose symptoms progressed over four to five months.

Her parents noticed increasing breathlessness, noisy breathing and a change in voice, especially during infections and while lying down — warning signs that led them to seek urgent medical care at Narayana Health SRCC Children’s Hospital, Mumbai.

Clinical examination revealed tracheal deviation, prompting immediate investigation. Advanced imaging, including ultrasound and contrast-enhanced CT scans, identified a complex anterior mediastinal mass arising from the thymic region, extending into the neck. The mass was found to be compressing and displacing the trachea, causing significant airway narrowing and placing the child at constant risk of respiratory distress.

A multidisciplinary paediatric team led by Dr. Rasikal Shah, Consultant Paediatric Surgeon, along with Dr. Pradeep K. Kaushik, carefully planned the surgical intervention. During surgery, intraoperative ultrasound revealed solid components, requiring an immediate change in strategy. The team proceeded with a median sternotomy to ensure complete and safe excision of the mass while protecting vital structures.

“The management of mediastinal masses in very young children is particularly challenging because even minor airway compromise can become life-threatening,” said Dr. Rasikal Shah. “This case demanded precise intraoperative judgement and seamless coordination between multiple specialties to achieve a safe outcome.”

The surgery involved meticulous dissection to safeguard the trachea, thymus and major mediastinal vessels, with minimal blood loss. Postoperatively, Abigail was closely monitored and showed a smooth recovery.

“Early recognition of airway compromise and the ability to adapt surgical planning in real time were critical to the success of this procedure,” said Dr. Pradeep K. Kaushik. “Such flexibility can make all the difference in complex paediatric cases.”

Histopathological analysis confirmed the mass to be benign, with features of myxoma/myxolipoma, bringing immense relief to the family. Abigail was discharged in stable condition.

Hospital officials noted that this case underscores the strength of SRCC’s multidisciplinary care model, integrating expertise from paediatric surgery, anaesthesia, radiology, pathology and critical care to deliver timely, life-saving treatment.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.