Under Pressure: A Rare Portrait of Cardiac Strain and Respiratory Distress in Mediastinal Neuroblastoma

Rahmanian, Mohsen; Khosropanah, Sarah; Khuban Azghadi, Amir Muhammad; Farhangi, Hamid

Volume 17, Issue 2 (June-2025 2025) Iranian Journal of Blood and Cancer 2025, 17(2): 13-23 | Back to browse issues page

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Rahmanian M, Khosropanah S, Khuban Azghadi A M, Farhangi H. Under Pressure: A Rare Portrait of Cardiac Strain and Respiratory Distress in Mediastinal Neuroblastoma. Iranian Journal of Blood and Cancer 2025; 17 (2) :13-23
URL: http://ijbc.ir/article-1-1695-en.html

Under Pressure: A Rare Portrait of Cardiac Strain and Respiratory Distress in Mediastinal Neuroblastoma

Mohsen Rahmanian¹

, Sarah Khosropanah ^*²

, Amir Muhammad Khuban Azghadi²

, Hamid Farhangi³

1- School of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran.
2- School of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran
3- Department of Pediatrics Hematology and Oncology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract: (836 Views)

Background: Neuroblastoma is the most common extracranial solid tumor in children, typically arising from the adrenal glands or abdominal sympathetic chain. Thoracic involvement, particularly in the posterior mediastinum, is rare and may present with nonspecific respiratory symptoms. When adjacent cardiac structures are compressed, clinical severity increases, posing diagnostic and therapeutic challenges.
Case Presentation: A one-year-old girl presented with persistent wheezing and recurrent pneumonia unresponsive to antibiotics. Initial imaging suggested pulmonary sequestration, but further evaluation—including echocardiography and angiography—revealed a posterior mediastinal mass compressing the left atrium and ventricle. Biopsy confirmed neuroblastoma. No metastasis was found on staging. Classified as intermediate-risk, she was treated per the Children’s Oncology Group (COG) A3961 protocol with chemotherapy. Treatment was well-tolerated, symptoms improved, and follow-up imaging showed significant tumor reduction without complications or recurrence.
Conclusion: Posterior mediastinal neuroblastoma may mimic common respiratory illnesses, delaying diagnosis. Cardiac compression can worsen symptoms and increase risks. Early recognition, accurate diagnosis, and multidisciplinary care are essential for favorable outcomes, as demonstrated by this case with no treatment complications or tumor recurrence on follow-up.

Keywords: Neuroblastoma, Chemotherapy, Pediatrics, Cardiac Compression, Thoracic Tumors

Full-Text [PDF 620 kb] (466 Downloads)

: Case report | Subject: Pediatric Hematology & Oncology
Received: 2025/03/25 | Accepted: 2025/06/15 | Published: 2025/06/30

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