Breathing Room: ECMO as a Bridge in Mediastinal Burkitt Leukemia

Introduction: Burkitt lymphoma is an aggressive, rapidly proliferating non-Hodgkin B-cell lymphoma. The sporadic form typically presents with abdominal involvement, while Burkitt leukemia denotes extensive marrow infiltration. Despite its intensity, both are highly chemosensitive, requiring urgent therapy.

Mediastinal involvement is rare in Burkitt lymphoma; however, anterior mediastinal masses are common in pediatric oncology and can cause critical airway obstruction. While diagnostic pathways to mitigate airway risks are well described, data on definitive airway management, especially with structural compromise, remain sparse.

We present a case of Burkitt leukemia complicated by tracheal degradation and tracheoesophageal fistula (TEF), managed by extracorporeal membrane oxygenation (ECMO) as a bridge to oncologic treatment and airway stabilization.


Description: A 12-year-old male presented with a week of chest pain and dyspnea. Imaging revealed a mediastinal mass extending from the thyroid to the subcarinal space, with significant tracheal compression. Initially stable on room air, he developed acute hypoxia and airway obstruction requiring emergent intubation. Bedside biopsy confirmed Burkitt lymphoma with bone marrow and peripheral blood involvement.

Following chemotherapy initiation, CT angiography showed intrathoracic tracheal degradation with air tracking near the carotid and innominate arteries.

Weeks later, acute endotracheal cuff failure highlighted extensive tracheal necrosis and a TEF. The patient was placed on venovenous (VV) ECMO for airway compromise. A multidisciplinary team is planning a custom tracheostomy, TEF repair, and potential tracheal reconstruction post-chemotherapy.


Discussion: Evidence supporting VV ECMO for mediastinal masses in children is limited, with most reports describing brief perioperative support for biopsy or resection. This case demonstrates a unique application: using ECMO for extended airway support in the setting of tracheal necrosis and TEF. In this context, VV ECMO served beyond gas exchange as a therapeutic bridge to enable treatment and multidisciplinary planning while reducing the need for deep sedation and neuromuscular blockade. This case underscores potential utility for early ECMO initiation in the setting of progressive airway degradation.