Life-Saving Emergency Decompression via a Clamshell Approach for Cardiac Arrest Caused by Hemorrhage of a Giant Mediastinal Ectopic Thyroid: A Case Report.

Authors

Minori Ono, Yui Watanabe, Takeo Togo, Yusuke Nakano, Ken Onodera, Hirotsugu Notsuda, Sakiko Kumata, Tetsuto Takeda, Takuya Ikushima, Tatsuaki Watanabe, Takaya Suzuki, Takashi Hirama, Hisashi Oishi, Yoshinori Okada

Published in

Surgical case reports. Volume 12. Issue 1. Epub Oct 22, 2026.

Abstract

Mediastinal ectopic thyroid tissue is rare and is usually asymptomatic. Intratumoral hemorrhage causing acute mediastinal compression and cardiac arrest is extremely uncommon. We report a case of cardiac arrest caused by hemorrhage of a giant mediastinal ectopic thyroid, successfully managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and emergency surgical decompression by tumor removal.
A 71-year-old woman with a long-standing anterior mediastinal tumor was transferred to our hospital because of dyspnea and shock after a fall. Contrast-enhanced CT revealed a giant anterior mediastinal tumor occupying the left hemithorax, with active extravasation and marked mediastinal deviation. Transarterial embolization was performed; however, she developed cardiac arrest shortly after embolization, presumably due to rapid tumor enlargement and severe mediastinal compression caused by intratumoral hemorrhage. Cardiopulmonary resuscitation was immediately initiated, and VA-ECMO was established. Emergency tumor removal and hemostasis were performed through a 4th-intercostal clamshell incision. The tumor occupied almost the entire left thoracic cavity and was extensively adherent to the chest wall and mediastinum, with particularly firm adhesion to the left brachiocephalic vein. The tumor was removed with combined resection of the left brachiocephalic vein. Histopathological examination revealed benign ectopic thyroid tissue without malignant findings. The postoperative course was complicated by bleeding, infection, acute kidney injury, and prolonged impaired consciousness. Postoperative hypothyroidism was identified after pathological confirmation of ectopic thyroid tissue, and levothyroxine replacement was initiated. The patient was transferred to a rehabilitation hospital on POD 72 and is currently living at home 1 year after surgery.
Giant mediastinal ectopic thyroid tissue can cause fatal circulatory collapse when complicated by intratumoral hemorrhage. Although the patient was in a critical condition, she was successfully rescued by VA-ECMO followed by emergency decompression through surgical tumor removal.

PMID:
42928950
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.

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