LBL-T-ALL com massa mediastinal anterior causando comprometimento das vias aéreas (stridor, ortopneia,...

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ID	`RF-T-ALL-MEDIASTINAL-AIRWAY`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-T-ALL`
Fontes	`SRC-BLAST-GOKBUGET-2018` `SRC-CALGB-10403-STOCK-2019` `SRC-NCCN-BCELL-2025`

Origem da bandeira vermelha

Definição	T-ALL/T-LBL with anterior mediastinal mass causing airway compromise (stridor, orthopnea, SVC syndrome features) or pericardial effusion with tamponade physiology — class-defining presentation in T-ALL
Direcção clínica	aguentar
Categoria	disfunção de órgãos
Algoritmo de deslocamentos	ALGO-T-ALL-1L

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "anterior_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": "svc_syndrome_present",
      "value": true
    }
  ],
  "type": "composite"
}

Notas

T-ALL/T-LBL anterior mediastinal mass is class-defining (~50-60% of T-ALL). Airway compromise + SVC syndrome are joint emergency presentations requiring HOLD on definitive induction — needs urgent steroids (prednisone or dexamethasone) to debulk, head-elevation, avoid supine GA. Per NCCN-BCELL ALL/LBL section: emergent steroid pre-phase before formal induction in symptomatic mediastinal mass. Per CALGB-10403: pediatric-inspired regimens begin with steroid pre-phase that addresses this. Direction HOLD because definitive induction is deferred until airway / SVC stabilized; priority 8 to win conflicts with TLS-emergency (which fires on the same patient). STUB — requires clinical co-lead signoff. Wiring suggestion: ALGO-T-ALL-1L step that branches on this RF to a steroid-pre-phase pathway before regimen selection.

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