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Anterior Mediastinal Mass Airway — FRCA Final MCQ

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HardAirway ManagementAnterior Mediastinal Mass AirwayFRCA Final

A 40-year-old man with a known anterior mediastinal mass (large thymoma, 10 cm) is scheduled for biopsy. CT shows significant compression of the trachea (50% reduction in cross-sectional area) and the right main pulmonary artery. He is asymptomatic when supine. What is the greatest anaesthetic risk?

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Correct answer: D — Complete airway obstruction and cardiovascular collapse on induction of general anaesthesia

Anterior mediastinal masses can cause life-threatening airway obstruction and cardiovascular collapse on induction of general anaesthesia. Loss of spontaneous ventilation (with muscle relaxants or deep anaesthesia) removes the negative intrathoracic pressure that splints the airway open, allowing the mass to compress the trachea and/or main bronchi. SVC or pulmonary artery compression can cause cardiovascular collapse. The safest approach is to maintain spontaneous ventilation (awake fibreoptic intubation or inhalational induction), have rigid bronchoscopy available, and be prepared to position the patient laterally or prone if obstruction occurs.

Reference: RCOA – 2023 – Thoracic anaesthesia module; Erdos G – 2018 – Anaesthesia for anterior mediastinal mass