Giant hemangioma of anterior mediastinum mimicking bilateral pleural effusion

Hemangioma is a rare mediastinal tumor corresponding to approximately 4–8% of all benign tumors in children and less than 0.5% in the overall population [1]. In more than half of cases it is situated in the anterior mediastinum and in 75% it affects young patients under 35 years of age in similar frequency in both sexes [1, 2].
The case of a huge hemangioma in the anterior mediastinum, radically removed during thoracotomy, diagnosed in a 22-year-old patient, is presented.
A 22-year-old man, without history of disease, was admitted to the hospital in a severe general condition with respiratory failure. The patient reported dyspnea at rest, increasing for 2 months. On the day of admission, all laboratory tests, including β-human chorionic gonadotropin (β-HCG) and α-fetoprotein (AFP), did not reveal any abnormalities, except for an arterial blood gas test that demonstrated significant hypoxemia. The patient had not been subjected to a chest radiograph before.
The chest radiograph demonstrated a total opacity of the left and 2/3 of the upper half of the chest (Fig. 1). In the chest computed tomography (CT) scan, an encysted extensive nodular lesion, filled with a heterogeneous fluid, was described (Fig. 2). The tumor filled almost the entire left pleural cavity, causing atelectasis of the left lung, and displaced the mediastinum with the heart and large vessels to the right side. The lesion also filled the upper and anterior part of the right pleural cavity, arranged along the anterior chest wall from the diaphragm to the level of the 4th intercostal space, with atelectasis of the middle lobe. Echocardiography did not reveal any impairment of the heart or pericardial cavity. The ultrasound examinations of the abdomen, neck and testicles were normal.
Because of life-threatening symptoms the left pleural cavity was punctured, evacuating approximately 1500 ml of bloody fluid. A cytological examination of the pleural fluid was negative. After improvement in the patient’s general condition was achieved, diagnostic left-sided video-assisted thoracic surgery (VATS) was performed. During the procedure, after the introduction of trocars, significant bleeding from the pleural cavity was observed. Video-assisted thoracic surgery was immediately converted to left anterolateral thoracotomy, under the fifth rib, and a cystoid, smoothly encysted elastic tumor involving both pleural cavities and the anterior mediastinum was recognized. The tumor, filled...


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