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Panagopoulos N, Leivaditis V, Kraniotis P, Ravazoula P, Koletsis E, Dougenis D. Sclerosing Mediastinitis Causing Unilateral Pulmonary Edema Due to Left Atrial and Pulmonary Venous Compression. A Case Report and Literature Review. Braz J Cardiovasc Surg 2019; 34:85-92. [PMID: 30810679 PMCID: PMC6385839 DOI: 10.21470/1678-9741-2018-0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/08/2018] [Indexed: 12/01/2022] Open
Abstract
Sclerosing mediastinitis (SM), previously named chronic fibrosing mediastinitis,
is an inflammatory process that in its end-stage results to sclerosis around the
mediastinal structures. SM is quite rare and has been correlated with
inflammatory and autoimmune diseases, as well as malignancy. SM may either
present in a mild form, with minor symptoms and a benign course or in a more
aggressive form with severe pulmonary hypertension and subsequent higher
morbidity and mortality. The diagnosis of SM may be difficult and quite
challenging, as symptoms depend on the mediastinal structure that is mainly
involved; quite often the superior vena cava. However, practically any
mediastinal structure may be involved by the fibrotic process, such as the
central airways, as well as the pulmonary arteries and veins, leading to
obstruction or total occlusion. The latter may be impossible to undergo proper
surgical excision of the lesion, and is considered to be a real challenge to the
surgeon. We herein report a case of SM that presented with arterial and venous
compression. The imaging appearance was that of unilateral pulmonary edema,
associated with lung collapse. The case is supplemented by a non-systematic
review of the relevant literature.
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Affiliation(s)
| | - Vasileios Leivaditis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece.,Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
| | | | | | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
| | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
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Patterson J, Graham D, George A, Will M, Sutter D. Right Middle Lobe Collapse and Pleural Effusion in an 18-Year-Old Man. Chest 2017; 152:e33-e38. [PMID: 28797398 DOI: 10.1016/j.chest.2017.04.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022] Open
Abstract
An 18-year-old African American male subject presented to an acute care clinic with 3 days of productive cough, chills, pleuritic right chest pain, sore throat with hoarseness, congestion, and intermittent shortness of breath. He recently relocated to Texas from Georgia to undergo basic military training. He denied any other recent travel or contact with persons with pulmonary TB or other respiratory illnesses. His medical history was significant for glucose-6-phosphate dehydrogenase deficiency and sickle cell trait.
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Affiliation(s)
- Joshua Patterson
- Department of Pediatrics, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - David Graham
- Department of Cardiothoracic Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - Alan George
- Department of Pathology, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - Micah Will
- Department of Pathology, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - Deena Sutter
- Department of Pediatrics, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX.
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Abstract
A presence of black pigmentation involving the endobronchial tree is not uncommon. It was first described in the literature in association with occupational exposure in the early 1940s. However, in 2003, Packham and Yeow formally used the term black bronchoscopy to describe endobronchial metastasis from a malignant melanoma. Hyperpigmentation of the airway, however, is associated with multiple etiologies such as congenital disease, inborn errors of metabolism, infections, environmental exposures, neoplasm, and iatrogenic causes. Although the majority of these conditions are benign, a proper diagnosis is important for optimal management. In this article, we review the etiology of black bronchoscopy and discuss its presentations and current management guidelines.
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Affiliation(s)
| | - Tanmay S Panchabhai
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Danai Khemasuwan
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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Boonsarngsuk V, Suwatanapongched T, Rochanawutanon M. Bronchial anthracostenosis with mediastinal fibrosis associated with long-term wood-smoke exposure. Respirology 2009; 14:1060-3. [PMID: 19740268 DOI: 10.1111/j.1440-1843.2009.01604.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bronchial anthracostenosis describes a disease entity consisting of bronchial destruction, deformity and stenosis related to dark pigmentation on bronchoscopy in patients with a history of coal workers' pneumoconiosis or chronic exposure to biomass smoke. The combined occurrence of bronchial anthracostenosis and mediastinal fibrosis in association with wood-smoke exposure has not been previously reported. This case report describes a non-cigarette smoking elderly woman who developed bronchial anthracostenosis and mediastinal fibrosis after long-term exposure to wood smoke. Clinical and radiological improvements were achieved after treatment with corticosteroid and tamoxifen. Awareness of this unusual entity will help to avoid misdiagnosis of malignancy or unnecessary thoracotomy.
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Affiliation(s)
- Viboon Boonsarngsuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Ikeda K, Nomori H, Mori T, Kobayashi H, Iwatani K, Yoshimoto K, Yoshioka M. Successful Steroid Treatment for Fibrosing Mediastinitis and Sclerosing Cervicitis. Ann Thorac Surg 2007; 83:1199-201. [PMID: 17307498 DOI: 10.1016/j.athoracsur.2006.09.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Revised: 08/09/2006] [Accepted: 09/05/2006] [Indexed: 11/24/2022]
Abstract
The use of steroids to successfully treat a 75-year-old woman with fibrosing mediastinitis and sclerosing cervicitis causing a stricture of the left common carotid artery is reported. Biopsy specimens showed collagenous fibers and fibroblasts with moderate infiltration of lymphocytes. The mediastinal and neck lesions were significantly reduced, with almost complete resolution of arterial stricture, 3 months after initiating administration of prednisolone at 20 mg/d.
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Affiliation(s)
- Koei Ikeda
- Department of Thoracic Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan
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Akman C, Kantarci F, Cetinkaya S. Imaging in mediastinitis: a systematic review based on aetiology. Clin Radiol 2004; 59:573-85. [PMID: 15208062 DOI: 10.1016/j.crad.2003.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2003] [Revised: 12/10/2003] [Accepted: 12/14/2003] [Indexed: 10/26/2022]
Abstract
Mediastinitis refers to inflammation of the tissues located in the middle chest cavity. It can be secondary to infectious or non-infectious causes and depending on the aetiology may be acute or chronic. The majority of cases of acute mediastinitis are secondary to oesophageal perforation and open chest surgery. Less common causes include tracheal, bronchial perforation or direct extension of infection from adjacent tissues. Chronic or slowly developing mediastinitis mostly arise from tuberculosis, histoplasmosis, other fungal infections, cancer, or sarcoidosis. In a minority of cases the aetiology is lymphatic obstruction or an autoimmune disease. Radiological imaging plays an essential role in the diagnosis and therapeutic approach to mediastinitis. Generally, the initial radiological work-up includes radiographic studies either with or without contrast material. However, conventional chest radiography may be misleading in the diagnosis of mediastinitis. Cross-sectional imaging techniques are generally required for diagnosis and evaluation of the site and extent of mediastinal involvement. Computed tomography and magnetic resonance imaging may also guide the choice of the optimal therapeutic approach.
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Affiliation(s)
- C Akman
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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Deussing EC, Daroca PJ, Nemechek AJ. Sclerosing cervicitis: report of a skull base lesion with literature review. Head Neck 2003; 25:778-83. [PMID: 12953315 DOI: 10.1002/hed.10305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Invasive fibrosclerotic lesions of the head and neck outside of the thyroid and orbit are extremely rare. To date 13 cases of sclerosing cervicitis have been described in the literature. METHODS We present a case of a sclerosing inflammatory lesion encountered at the skull base in a 49-year-old woman. RESULTS After surgical excision and pathologic examination, this lesion was identified as sclerosing cervicitis. CONCLUSIONS This case report contributes to an awareness of a rare lesion of the head and neck that presents clinical and treatment challenges for surgeons managing these patients.
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Affiliation(s)
- Eric C Deussing
- Tulane University Health Sciences Center, New Orleans, Louisiana, USA
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Abstract
Fibrosing mediastinitis is a rare benign disorder caused by proliferation of acellular collagen and fibrous tissue within the mediastinum. Although many cases are idiopathic, many (and perhaps most) cases in the United States are thought to be caused by an abnormal immunologic response to Histoplasma capsulatum infection. Affected patients are typically young and present with signs and symptoms of obstruction or compression of the superior vena cava, pulmonary veins or arteries, central airways, or esophagus. There may be two types of fibrosing mediastinitis: focal and diffuse. The focal type usually manifests on computed tomographic (CT) or magnetic resonance (MR) images as a localized, calcified mass in the paratracheal or subcarinal regions of the mediastinum or in the pulmonary hila. The diffuse type manifests on CT or MR images as a diffusely infiltrating, often noncalcified mass that affects multiple mediastinal compartments. CT and MR imaging play a vital role in the diagnosis and management of fibrosing mediastinitis.
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Affiliation(s)
- S E Rossi
- Deprtment of Radiology, Buenos Aires, Argentina
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Carretero Gracia JA, Alvarez Alegret R, Peñalver Cuesta JC. [Chronic sclerosing mediastinitis: infrequent cause of unilateral diaphragmatic paralysis]. Arch Bronconeumol 2000; 36:417-9. [PMID: 11000931 DOI: 10.1016/s0300-2896(15)30142-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Chronic sclerosing mediastinitis (CSM) is a rare disease whose etiology varies and which usually develops through mediastinal compression syndromes, generally due to occlusion of the superior vena cava. We report a case of CSM diagnosed after a chance finding of unilateral diaphragm paralysis, a circumstance not previously reported in the literature. We review the clinical, radiological and histological features of CSM.
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Savelli BA, Parshley M, Morganroth ML. Successful treatment of sclerosing cervicitis and fibrosing mediastinitis with tamoxifen. Chest 1997; 111:1137-40. [PMID: 9106605 DOI: 10.1378/chest.111.4.1137] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Fibrosing mediastinitis and sclerosing cervicitis are fibrosclerotic disorders akin to retroperitoneal fibrosis, with presenting symptoms related to local pain or viscus obstruction or both. No definitive treatment is known. This is the first report of these disorders dramatically responding to tamoxifen citrate and prednisone.
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Affiliation(s)
- B A Savelli
- Providence Medical Center, Department of Medical Education, Oregon Health Sciences University, Portland, USA
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