Tumor lysis syndrome and mediastinal mass

Abstract Tumor lysis syndrome is triggered by rapid malignant cell destruction following chemotherapy, immunotherapy, or radiation and is usually seen in leukemias and lymphomas. It leads to the release of intracellular contents causing metabolic disturbances such as hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypokalcemia. These imbalances can result in acute kidney injury, cardiac arrhythmias, seizures, and death. Management involves vigilant monitoring in high-risk cases, aggressive IV hydration, and pharmacologic interventions including allopurinol and rasburicase. Anterior mediastinal masses (AMMs) in children commonly lymphomas represent a critical oncologic emergency due to their potential to cause life-threatening respiratory and cardiovascular compromise. AMMs often compress vital thoracic structures, leading to symptoms such as cough, dyspnea, stridor, orthopnea, syncope, and superior vena cava (SVC) syndrome. These effects are exacerbated under anesthesia. Risk stratification based on clinical symptoms and imaging findings is essential to guide safe diagnostic and anesthetic planning. Anesthetic management prioritizes spontaneous ventilation, strategic positioning, and readiness for emergency interventions. SVC syndrome results from the obstruction of the SVC by mediastinal masses. This can lead to head-and-neck edema and acute and rapid development of symptoms of blood flow obstruction, respiratory compromise, and neurologic manifestations.