PMBCL with bulky anterior mediastinal mass (≥10 cm) causing airway compromise (stridor, o...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-PMBCL-MEDIASTINAL-AIRWAY`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-PMBCL`
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	PMBCL with bulky anterior mediastinal mass (≥10 cm) causing airway compromise (stridor, orthopnea, supine intolerance, post-obstructive pneumonia) or pericardial effusion with tamponade physiology
Clinical direction	hold
Category	organ-dysfunction
Shifts algorithm	ALGO-PMBCL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "mediastinal_mass_cm",
      "threshold": 10
    },
    {
      "finding": "stridor_or_airway_compromise",
      "value": true
    },
    {
      "finding": "orthopnea_supine_intolerance",
      "value": true
    },
    {
      "finding": "pericardial_effusion_tamponade",
      "value": true
    },
    {
      "finding": "post_obstructive_pneumonia",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

Bulky mediastinal mass (≥10 cm) is in the PMBCL diagnostic criteria (WHO 5th ed.) and is the dominant prognostic factor. Per NCCN B-cell PMBCL section: emergency steroid debulking, head elevation, avoid general anesthesia in supine; CT-guided percutaneous core biopsy if airway too compromised for surgical biopsy. Direction HOLD until airway/circulation stabilized; priority 8. STUB — requires clinical co-lead signoff.

Used By

No reverse references found in the YAML corpus.