Laparoscopic management of a posterior mediastinal tumor mimicking an adrenal neoplasm.
BACKGROUND
Rarely, a posterior mediastinal mass may mimic an adrenal tumor on preoperative computed tomography scan. The intraoperative discovery that a mass thought to be associated with the adrenal gland actually is above the diaphragm in the posteroinferior mediastinum poses a challenge for the laparoscopic surgeon. Conversion to a thoracotomy or to videothoracoscopy incurs additional morbidity and risk for the patient.


METHODS
We describe a technique for the transdiaphragmatic removal of a benign mass from the posterior mediastinum. A posterior mediastinal tumor was detected during a laparoscopic procedure for a suspected right adrenal tumor. Frozen section proved benign, and the mass was resected laparoscopically via transdiaphragmatic access to the posterior mediastinum.


RESULTS
No complications were noted during or after surgery. The patient was ready for discharge from the hospital on postoperative day 1.


CONCLUSIONS
Transdiaphragmatic resection was done successfully instead of conversion to a thoracotomy or thoracoscopic procedure for a benign posterior mediastinal tumor found incidentally during laparoscopic surgery for a presumed adrenal lesion. This transdiaphragmatic approach can be applied to selected benign mediastinal masses.
Berber
E
E
Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A80, Cleveland, OH 44195 USA.
String
A
A
Garland
A M
AM
Engle
K
K
Siperstein
A
A
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis*; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008481:Mediastinoscopy / Q000379:methods*; D008637:Mesenchymoma / Q000175:diagnosis / Q000601:surgery; D009442:Neurilemmoma / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome