Massive cervico-thoracic ganglioneuroma with subclavian artery encasement in A 4-year-old girl: A case report

Introduction Cervico-thoracic ganglioneuromas are rare, benign neurogenic tumors that are rare in children under five years of age. Management of acute airway compromise caused by a massive superior mediastinal mass extending into the neck with critical vascular encasement is challenging. Case Presentation A four-year-old girl presented with fever, persistent cough, and progressive respiratory distress. Magnetic Resonance Imaging revealed a massive lobulated mass of 5.7*7*9.2 cms occupying the superior, posterior, and middle mediastinum, extending into the lower neck and completely encasing the right subclavian artery. A multidisciplinary pediatric and cardiothoracic team performed a near-total surgical debulking through a cervico-thoracic approach (with a midline sternotomy extending into the neck towards right), intentionally leaving a small residual cuff of tumor to avoid catastrophic injury to the encased subclavian vessels. Postoperative histopathology confirmed a mature ganglioneuroma with clusters of mature ganglion cells and a dense stroma of Schwann cells. The patient was successfully extubated on postoperative day 1, discharged on day 13, and remains completely asymptomatic at her three-month follow-up. Conclusion Surgical debulking may be a safe and effective treatment strategy for benign pediatric ganglioneuromas when complete excision poses a high risk of major neurovascular injury.