Clamshell thoracotomy for pediatric tumor resection: A case series

Large masses in the pleural cavity or mediastinum in pediatric patients may present an operative challenge, not only in terms of obtaining adequate space in the small chest for safe dissection, but in attaining adequate chest closure. Three adolescent males presented with large masses in the mediastinum or thoracic cavity. Their presenting signs were primarily chronic cough and chest pain. Patient 1 was a 13-year-old male with a history of spina bifida and a 12 x 10 x 9 cm malignant germ cell tumor in the mediastinum / right chest. After the tumor resection, the sternum was over a metal plate. Patient 2 was an 18-year-old male with a 24 x 15 x 11 cm right thoracic synovial sarcoma in the posterior mediastinum / right hemithorax. In addition to the clamshell thoracotomy, the abdomen had to be accessed through a midline incision to obtain adequate tumor exposure. His postoperative course was complicated by a surgical site infection. Patients 3 was a 14-year-old male with a 19 x 14 x 10 cm lymphovascular malformation in the posterior mediastinum / right hemithorax. After the resection of the tumor, sternal plating was used during the wound closure. The bilateral clamshell thoracotomy is a suitable approach for the resection of extensive mediastinal and thoracic masses in adolescents. The use of a sternal plate leads to adequate sternal healing.