European Journal of Pediatrics

, Volume 168, Issue 11, pp 1395–1399 | Cite as

Mediastinal masses masquerading as common respiratory conditions of childhood: a case series

  • A. Saraswatula
  • D. McShane
  • D. Tideswell
  • G. A. A. Burke
  • D. M. Williams
  • J. C. Nicholson
  • M. J. MurrayEmail author
Short Report



Leukaemia and lymphoma may present with symptoms and signs mimicking common respiratory conditions of childhood such as asthma or croup. The UK National Institute for Clinical Excellence guidelines for referral for suspected cancer state that “the primary healthcare professional should be ready to review the initial diagnosis in patients in whom common symptoms do not resolve as expected” and “must be alert to the possibility of cancer when confronted by unusual symptom patterns” (National Institute for Health and Clinical Excellence, 2005).

Results and discussion

A child with an undiagnosed mediastinal mass presenting with signs and symptoms suggestive of asthma or croup may be given oral systemic steroids. We report four such illustrative cases presenting to a single institution within the last 3 years.


We highlight key points from the history and examination findings which should lead to review of the original diagnosis, the benefit of early chest X-ray in such cases and the dangers of steroid pretreatment.


Asthma Cancer Chest X-ray Croup Leukaemia Lymphoma 






Conflict of interest



  1. 1.
    British Thoracic Society Scottish Intercollegiate 3 Guidelines Network (2007) British guideline on the management of asthma: a national clinical guideline. (accessed 11th December 2008)
  2. 2.
    Crist WM, Shuster JJ, Falletta J et al (1988) Clinical features and outcome in childhood T-cell leukemia–lymphoma according to stage of thymocyte differentiation: a Pediatric Oncology Group Study. Blood 72(6):1891–1897PubMedGoogle Scholar
  3. 3.
    Duzova A, Cetin M, Gumruk F et al (2001) Acute tumour lysis syndrome following a single-dose corticosteroid in children with acute lymphoblastic leukaemia. Eur J Haematol 66(6):404–407. doi: 10.1034/j.1600-0609.2001.066006404.x PubMedCrossRefGoogle Scholar
  4. 4.
    Frost I, Ross-Russell R, Bass S, Burke A (2007) A rapidly advancing mediastinal mass—overcoming tracheobronchial obstruction. Paediatr Anaesth 17(9):893–896. doi: 10.1111/j.1460-9592.2007.02246.x PubMedCrossRefGoogle Scholar
  5. 5.
    Heinz P, Dunne J (2004) Wheeze and mediastinal mass: a challenging patient. Emerg Med Australas 16(3):241–243. doi: 10.1111/j.1742-6723.2004.00573.x PubMedCrossRefGoogle Scholar
  6. 6.
    Lam JC, Chui CH, Jacobsen AS et al (2004) When is a mediastinal mass critical in a child? An analysis of 29 patients. Pediatr Surg Int 20(3):180–184. doi: 10.1007/s00383-004-1142-6 PubMedCrossRefGoogle Scholar
  7. 7.
    McDonnell C, Barlow R, Campisi P et al (2008) Fatal peri-operative acute tumour lysis syndrome precipitated by dexamethasone. Anaesthesia 63(6):652–655. doi: 10.1111/j.1365-2044.2007.05436.x PubMedCrossRefGoogle Scholar
  8. 8.
    National Institute for Health and Clinical Excellence (2005) Referral guidelines for suspected cancer. (accessed 11th December 2008)
  9. 9.
    Peet A, Grundy R, Morland B, Stevens M (2001) Differential diagnoses for asthma should include mediastinal masses. BMJ 322(7281):302. doi: 10.1136/bmj.322.7281.302 PubMedCrossRefGoogle Scholar
  10. 10.
    Revesz T, Kardos G, Kajtar P, Schuler D (1985) The adverse effect of prolonged prednisolone pretreatment in children with acute lymphoblastic leukemia. Cancer 55(8):1637–1640. doi: 10.1002/1097-0142(19850415)55:8<1637::AID-CNCR2820550804>3.0.CO;2-H PubMedCrossRefGoogle Scholar
  11. 11.
    Smyth RL (2002) Asthma: a major pediatric health issue. Respir Res 3(Suppl 1):S3–S7. doi: 10.1186/rr188 PubMedCrossRefGoogle Scholar
  12. 12.
    Steliarova-Foucher E, Stiller C, Kaatsch P et al (2004) Geographical patterns and time trends of cancer incidence and survival among children and adolescents in Europe since the 1970s (the ACCISproject): an epidemiological study. Lancet 364(9451):2097–2105. doi: 10.1016/S0140-6736(04)17550-8 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • A. Saraswatula
    • 1
  • D. McShane
    • 1
  • D. Tideswell
    • 3
  • G. A. A. Burke
    • 2
  • D. M. Williams
    • 2
  • J. C. Nicholson
    • 2
  • M. J. Murray
    • 2
    Email author
  1. 1.Paediatric Pulmonology DepartmentAddenbrooke’s Hospital NHS Foundation TrustCambridgeUK
  2. 2.Paediatric Haematology and Oncology DepartmentAddenbrooke’s Hospital NHS Foundation TrustCambridgeUK
  3. 3.General PracticeEssexUK

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