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Fatal anterior mediastinal mass in a pregnant lady

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Abstract

We report a fatal case of a 26-year-old nulliparous woman who presented with an anterior mediastinal mass in her late pregnancy. She had complained of a progressively increasing neck swelling and occasional dry cough in the early second trimester, which was associated with worsening dyspnoea, reduced effort tolerance and orthopnoea. Ultrasound of the neck showed an enlarged lymph node, and chest X-ray revealed mediastinal widening. At 35 weeks’ gestation, the patient was referred to a tertiary centre for a computed tomography (CT) scan of the neck and thorax under elective intubation via awake fibreoptic nasal intubation as she was unable to lie flat. However, she developed sudden bradycardia, hypotension and desaturation soon after being positioned supine, which required resuscitation. She succumbed after 3 days in the intensive care unit. An autopsy revealed a large anterior mediastinal mass extending to the right supraclavicular region, displacing the heart and lungs, encircling the superior vena cava and right internal jugular vein with tumour thrombus extending into the right atrium. Histopathology examination of the mediastinal mass confirmed the diagnosis of a primary mediastinal large B-cell lymphoma. This report emphasizes the severe and fatal outcome resulting from the delay and misinterpretation of symptoms related to a mediastinal mass.

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Acknowledgements

The authors would like to thank the staffs of the National Institute of Forensic Medicine, Malaysia, who involved in this case as well as the Director General of Health Malaysia for his permission to publish this article.

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Authors and Affiliations

  1. Department of Forensic Pathology, University of Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia

    Zhao Peng Koo

  2. National Institute of Forensic Medicine, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia

    Mansharan Kaur Chainchel Singh & Sheue Feng Siew

  3. Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi Mara (UiTM), Sg Buloh, Selangor, Malaysia

    Mansharan Kaur Chainchel Singh

  4. Faculty of Medicine, Universiti Teknologi Mara (UiTM), Sg Buloh, Selangor, Malaysia

    Mansharan Kaur Chainchel Singh

  5. Department of Radiology, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia

    Mohamad Helmee Bin Mohamad Noor

  6. Department of Pathology, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia

    Norhayati Binti Omar

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  1. Zhao Peng Koo
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Contributions

Conception and design or analysis and interpretation of data: Koo Zhao Peng, Mansharan Kaur Chainchel Singh, Mohamad Helmee Bin Mohamad Noor, Norhayati Binti Omar. Drafting the article or revising it critically for important intellectual content: Koo Zhao Peng, Mansharan Kaur Chainchel Singh, Siew Sheue Feng. Final approval of the version to be published: Koo Zhao Peng, Mansharan Kaur Chainchel Singh, Mohamad Helmee Bin Mohamad Noor, Norhayati Binti Omar

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Correspondence to Zhao Peng Koo.

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The study protocol for this research was approved by the National Medical Research Registry, Ministry of Health Malaysia.

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Koo, Z., Chainchel Singh, M., Mohamad Noor, M.B. et al. Fatal anterior mediastinal mass in a pregnant lady. Forensic Sci Med Pathol 20, 226–232 (2024). https://doi.org/10.1007/s12024-023-00669-4

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