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Mediastinal Mass Child CT — FRCA Final MCQ

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HardPaediatric AnaesthesiaMediastinal Mass Child CTFRCA Final

A 3-year-old child (15 kg) requires a CT scan under general anaesthesia. He has a large anterior mediastinal mass (lymphoma) causing 60% tracheal compression. He is asymptomatic in the supine position. Which is the safest anaesthetic approach?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — No anaesthesia is needed for CT – use distraction techniques only

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · C = shown as D · B = shown as E

In a child with significant anterior mediastinal mass causing 60% tracheal compression, even in an apparently asymptomatic child, induction of anaesthesia poses extreme risk. However, the child is only 3 years old and the procedure is a diagnostic CT scan. The safest approaches are: (1) attempt CT without sedation using age-appropriate distraction/play therapy, (2) if anaesthesia is essential, maintain spontaneous ventilation throughout (inhalational induction with sevoflurane, no muscle relaxants), have rigid bronchoscopy immediately available, and be prepared to turn prone if airway obstruction occurs. B is acceptable if sedation-free scanning fails.

Reference: APA/DAS – 2015 – Paediatric difficult airway; RCOA – 2023 – Paediatric oncological anaesthesia