Life-Saving Emergency Decompression via a Clamshell Approach for Cardiac Arrest Caused by Hemorrhage of a Giant Mediastinal Ectopic Thyroid: A Case Report.
- 1Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.
Abstract
Introduction
Mediastinal ectopic thyroid tissue is rare and is usually asymptomatic. Intratumoral hemorrhage causing acute mediastinal compression and cardiac arrest is extremely uncommon. We report a case of cardiac arrest caused by hemorrhage of a giant mediastinal ectopic thyroid, successfully managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and emergency surgical decompression by tumor removal.Case presentation
A 71-year-old woman with a long-standing anterior mediastinal tumor was transferred to our hospital because of dyspnea and shock after a fall. Contrast-enhanced CT revealed a giant anterior mediastinal tumor occupying the left hemithorax, with active extravasation and marked mediastinal deviation. Transarterial embolization was performed; however, she developed cardiac arrest shortly after embolization, presumably due to rapid tumor enlargement and severe mediastinal compression caused by intratumoral hemorrhage. Cardiopulmonary resuscitation was immediately initiated, and VA-ECMO was established. Emergency tumor removal and hemostasis were performed through a 4th-intercostal clamshell incision. The tumor occupied almost the entire left thoracic cavity and was extensively adherent to the chest wall and mediastinum, with particularly firm adhesion to the left brachiocephalic vein. The tumor was removed with combined resection of the left brachiocephalic vein. Histopathological examination revealed benign ectopic thyroid tissue without malignant findings. The postoperative course was complicated by bleeding, infection, acute kidney injury, and prolonged impaired consciousness. Postoperative hypothyroidism was identified after pathological confirmation of ectopic thyroid tissue, and levothyroxine replacement was initiated. The patient was transferred to a rehabilitation hospital on POD 72 and is currently living at home 1 year after surgery.Conclusions
Giant mediastinal ectopic thyroid tissue can cause fatal circulatory collapse when complicated by intratumoral hemorrhage. Although the patient was in a critical condition, she was successfully rescued by VA-ECMO followed by emergency decompression through surgical tumor removal.
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BibTeX
@article{ono2026lifesaving,
title = {{Life-Saving Emergency Decompression via a Clamshell Approach for Cardiac Arrest Caused by Hemorrhage of a Giant Mediastinal Ectopic Thyroid: A Case Report.}},
author = {Minori Ono and Yui Watanabe and Takeo Togo and Yusuke Nakano and Ken Onodera and Hirotsugu Notsuda and Sakiko Kumata and Tetsuto Takeda and Takuya Ikushima and Tatsuaki Watanabe and Takaya Suzuki and Takashi Hirama and Hisashi Oishi and Yoshinori Okada},
journal = {Surgical case reports},
year = {2026},
month = oct,
doi = {10.70352/scrj.cr.26-0494},
url = {https://europepmc.org/article/MED/42928950},
note = {CC BY},
}
RIS
TY - JOUR
TI - Life-Saving Emergency Decompression via a Clamshell Approach for Cardiac Arrest Caused by Hemorrhage of a Giant Mediastinal Ectopic Thyroid: A Case Report.
AU - Minori Ono
AU - Yui Watanabe
AU - Takeo Togo
AU - Yusuke Nakano
AU - Ken Onodera
AU - Hirotsugu Notsuda
AU - Sakiko Kumata
AU - Tetsuto Takeda
AU - Takuya Ikushima
AU - Tatsuaki Watanabe
AU - Takaya Suzuki
AU - Takashi Hirama
AU - Hisashi Oishi
AU - Yoshinori Okada
PY - 2026
DA - 2026/10/22
JO - Surgical case reports
DO - 10.70352/scrj.cr.26-0494
UR - https://europepmc.org/article/MED/42928950
AB - Introduction Mediastinal ectopic thyroid tissue is rare and is usually asymptomatic. Intratumoral hemorrhage causing acute mediastinal compression and cardiac arrest is extremely uncommon. We report a case of cardiac arrest caused by hemorrhage of a giant mediastinal ectopic thyroid, successfully managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and emergency surgical decompression by tumor removal.Case presentation A 71-year-old woman with a long-standing anterior mediastinal tumor was transferred to our hospital because of dyspnea and shock after a fall. Contrast-enhanced CT revealed a giant anterior mediastinal tumor occupying the left hemithorax, with active extravasation and marked mediastinal deviation. Transarterial embolization was performed; however, she developed cardiac arrest shortly after embolization, presumably due to rapid tumor enlargement and severe mediastinal compression caused by intratumoral hemorrhage. Cardiopulmonary resuscitation was immediately initiated, and VA-ECMO was established. Emergency tumor removal and hemostasis were performed through a 4th-intercostal clamshell incision. The tumor occupied almost the entire left thoracic cavity and was extensively adherent to the chest wall and mediastinum, with particularly firm adhesion to the left brachiocephalic vein. The tumor was removed with combined resection of the left brachiocephalic vein. Histopathological examination revealed benign ectopic thyroid tissue without malignant findings. The postoperative course was complicated by bleeding, infection, acute kidney injury, and prolonged impaired consciousness. Postoperative hypothyroidism was identified after pathological confirmation of ectopic thyroid tissue, and levothyroxine replacement was initiated. The patient was transferred to a rehabilitation hospital on POD 72 and is currently living at home 1 year after surgery.Conclusions Giant mediastinal ectopic thyroid tissue can cause fatal circulatory collapse when complicated by intratumoral hemorrhage. Although the patient was in a critical condition, she was successfully rescued by VA-ECMO followed by emergency decompression through surgical tumor removal.
SN - 2198-7793
ER -