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Jia M, Su H, Jiang K, Wang A, Guo Z, Zhu H, Zhang F, Sun X, Shi Y, Pan X, Cao Y. Incidence and predictors of in-stent restenosis following intervention for pulmonary vein stenosis due to fibrosing mediastinitis. Orphanet J Rare Dis 2024; 19:379. [PMID: 39397011 PMCID: PMC11472477 DOI: 10.1186/s13023-024-03391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 10/03/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Fibrosing mediastinitis (FM) is a rare yet fatal condition, caused by different triggers and frequently culminating in the obstruction of the pulmonary vasculature and airways, often leading to pulmonary hypertension and right heart failure. Percutaneous transluminal pulmonary venoplasty (PTPV) is an emerging treatment for pulmonary vein stenosis (PVS) caused by FM. Our previous study showed as high as 24% of in-stent restenosis (ISR) in FM. However, the predictors of ISR are elusive. OBJECTIVES We sought to identify the predictors of ISR in patients with PVS caused by extraluminal compression due to FM. METHODS We retrospectively enrolled patients with PVS-FM who underwent PTPV between July 1, 2018, and December 31, 2022. According to ISR status, patients were divided into two groups: the ISR group and the non-ISR group. Baseline characteristics (demographics and lesions) and procedure-related information were abstracted from patient records and analyzed. Univariate and multivariate analyses were performed to determine the predictors of ISR. RESULTS A total of 142 stents were implanted in 134 PVs of 65 patients with PVS-FM. Over a median follow-up of 6.6 (3.4-15.7) months, 61 of 134 PVs suffered from ISR. Multivariate analysis demonstrated a significantly lower risk of ISR in PVs with a larger reference vessel diameter (RVD) (odds ratio (OR): 0.79; 95% confidence interval [CI]: 0.64 to 0.98; P = 0.032), and stenosis of the corresponding pulmonary artery (Cor-PA) independently increased the risk of restenosis (OR: 3.41; 95% CI: 1.31 to 8.86; P = 0.012). The cumulative ISR was 6.3%, 21.4%, and 39.2% at the 3-, 6-, and 12-month follow-up, respectively. CONCLUSION ISR is very high in PVS-FM, which is independently associated with RVD and Cor-PA stenosis. TRAIL REGISTRATION Chinese Clinical Trials Register; No.: ChiCTR2000033153. URL: http://www.chictr.org.cn .
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Affiliation(s)
- Mengfei Jia
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Hongling Su
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Kaiyu Jiang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Aqian Wang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Zhaoxia Guo
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Hai Zhu
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Fu Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Xuechun Sun
- Heart, Lung and Vessels Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, China
| | - Yiwei Shi
- NHC Key Laboratory of Pneumoconiosis, No.85 Jiefang South Road, Taiyuan, 030000, China.
- Shanxi Province Key Laboratory of Respiratory, Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, 030000, China.
| | - Xin Pan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Yunshan Cao
- Heart, Lung and Vessels Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, China.
- NHC Key Laboratory of Pneumoconiosis, No.85 Jiefang South Road, Taiyuan, 030000, China.
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2
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Yu YX, An L, Ma ZH, Shi HZ, Yang YH. A retrospective analysis of transudative pleural effusion due to fibrosing mediastinitis. J Cardiothorac Surg 2024; 19:467. [PMID: 39061098 PMCID: PMC11282832 DOI: 10.1186/s13019-024-02972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Pleural effusion caused by fibrosing mediastinitis is rarely reported. This study aimed to summarize the clinical manifestations, diagnosis and treatment of transudative pleural effusion due to fibrosing mediastinitis. METHODS Medical records and follow-up data of 7 patients with transudative pleural effusion due to fibrosing mediastinitis in Beijing Chaoyang Hospital between May 2014 and Feb 2018 were retrospectively analyzed. RESULTS These patients included 4 males and 3 females, with an average age of (64 ± 9) years. There were 3 left-sided effusions, 2 right-sided effusions and 2 bilateral effusions. Previous or latent tuberculosis was found in 6 patients. Pulmonary hypertension was indicated by echocardiography in all the 7 patients. Computed tomography pulmonary angiography (CTPA) of all the 7 cases showed increased soft tissue images visible in the mediastinum and bilateral hilus, different degrees of stenosis or occlusion in the pulmonary artery and pulmonary vein. In addition, 4 cases were found of right middle lobe atelectasis with a mediastinal window setting. There was interstitial pulmonary edema on the side of pleural effusion with a lung window setting. All the 7 patients were treated with intermittent drainage of pleural effusion combined with diuretic therapy. Five patients were treated with antituberculosis therapy. Up to now, two patients died of right heart failure and respiratory failure after 2 and 16 months respectively; The remaining 5 patients were still in follow up. CONCLUSION Fibrosing mediastinitis can lead to pulmonary vein stenosis or occlusion, and thus cause transudative pleural effusion, which can be detected by CTPA. Pulmonary hypertension, long time of cough, and a history of tuberculosis are common in these patients. The common therapy is intermittent drainage of pleural effusion combined with diuretic therapy.
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Affiliation(s)
- Yan-Xia Yu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
| | - Li An
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
| | - Zhan-Hong Ma
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China.
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3
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Van Kalsbeek D, Anani AR, El-Kersh K. Pulmonary artery vasodilators for treatment of pulmonary hypertension complicating fibrosing mediastinitis. Respir Med Case Rep 2024; 49:102006. [PMID: 38559326 PMCID: PMC10978528 DOI: 10.1016/j.rmcr.2024.102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Fibrosing mediastinitis (FM) is a heterogeneous disease characterized by sclerosing fibrosis of mediastinal structures. Pulmonary hypertension (PH) may complicate the course of the disease and can contribute significantly to the morbidity of FM. Due to the rarity and complexity of the disease, evidence-based guidelines are not currently available, and the optimal treatment approach is unknown. Management approaches should be individualized, and current techniques are often unsatisfactory. Here, we present two cases of PH complicating FM that were managed using pulmonary artery vasodilator therapy with excellent hemodynamic response.
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4
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Anderson Z, Ashkin A, Messina N, Ruthman C, Lindner D. Fibrosing mediastinitis resulting in unilateral pulmonary artery hypertension. Respir Med Case Rep 2024; 48:101998. [PMID: 38445190 PMCID: PMC10914577 DOI: 10.1016/j.rmcr.2024.101998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Fibrosing mediastinitis (FM), a rare disorder that is further classified as excessive fibrous tissue that occurs within the mediastinum. Classically, presenting with manifestations dependent on where the fibrous tissue is located. In rare instances, compression of pulmonary vasculature can lead to Pulmonary Hypertension. Pulmonary Hypertension- Fibrosing Mediastinitis (PH-FM) represents a rare complication with minimal available data on incidence. In regards to all-cause mortality, no specific data regarding the prognosis of PH-FM exist. With the scarcity of data, this case aids in the advancement of literature due to unique unilateral obstruction and the need for further analysis on our current treatment.
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Affiliation(s)
- Zackary Anderson
- Internal Medicine Resident Physician, Naples Community Hospital, 311 9th St North Suite 201 Naples, FL 34102, USA
| | - Alex Ashkin
- Internal Medicine Resident Physician, Naples Community Hospital, 311 9th St North Suite 201 Naples, FL 34102, USA
| | - Noelle Messina
- Medicine Resident Physician, Naples Community Hospital, 311 9th St North Suite 201 Naples, FL 34102, USA
| | - Carl Ruthman
- Pulmonary and Critical Care Attending Physician Naples Community Hospital, 311 9th St North Suite 201 Naples, FL 34102, USA
| | - David Lindner
- Pulmonary and Critical Care Attending Physician Naples Community Hospital, 311 9th St North Suite 201 Naples, FL 34102, USA
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5
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Westhoff M, Hardebusch T, Litterst P, Breithecker A, Haas M, Kuniss M, Neumann T, Guth S, Wiedenroth CB. Successful simultaneous stenting of a pulmonary artery and vein in pulmonary vascular stenosis due to silicosis. Case report and literature review. Front Cardiovasc Med 2023; 10:1108768. [PMID: 37229232 PMCID: PMC10203551 DOI: 10.3389/fcvm.2023.1108768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/16/2023] [Indexed: 05/27/2023] Open
Abstract
A 58-year-old patient was admitted to the emergency department due to severe respiratory insufficiency. Anamnesis revealed that the patient had experienced increasing stress dyspnea for a few months. Upon imaging, an acute pulmonary embolism was excluded, but peribronchial and hilar soft tissue proliferation with compression of central parts of the pulmonary circulation was found. The patient had a history of silicosis. The histology report showed tumor-free lymph node particles with prominent anthracotic pigment and dust depositions without evidence of IgG4-associated disease. The patient was administered steroid therapy and underwent simultaneous stenting of the left interlobular pulmonary artery and the upper right pulmonary vein. As a result, a significant improvement in symptoms and physical performance was achieved. The diagnosis of inflammatory or, in particular, fibrosing mediastinal processes can be challenging and important clinical symptoms must be taken into account, especially if the pulmonary vasculature is involved. In such cases, the possibility of interventional procedures should be examined in addition to drug therapy options.
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Affiliation(s)
- M. Westhoff
- Department of Pulmonology, Klinik für Pneumologie, Schlaf und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer, Germany
- Universität Witten/Herdecke University, Witten, Germany
| | - T. Hardebusch
- Department of Pulmonology, Klinik für Pneumologie, Schlaf und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer, Germany
| | - P. Litterst
- Department of Pulmonology, Klinik für Pneumologie, Schlaf und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer, Germany
| | - A. Breithecker
- Department of Radiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - M. Haas
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - M. Kuniss
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - T. Neumann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - S. Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - C. B. Wiedenroth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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6
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Yang S, Wang J, Li J, Huang K, Yang Y. Refractory pleural effusion as a rare complication of pulmonary vascular stenosis induced by fibrosing mediastinitis: a case report and literature review. J Int Med Res 2021; 49:3000605211010073. [PMID: 33947262 PMCID: PMC8113940 DOI: 10.1177/03000605211010073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Fibrosing mediastinitis (FM) is a progressive, life-threatening disease
characterized by extrinsic compression of mediastinal bronchovascular
structures, and the clinical manifestations largely depend upon the
affected structures. Pleural effusion is rarely reported in patients
with FM. We herein describe a 70-year-old man who presented with
recurrent breathlessness and refractory left pleural effusion. He was
misdiagnosed with and treated for tuberculous pleurisy for several
months. Thoracentesis revealed a transudative pleural effusion, and a
contrast-enhanced computed tomography scan of the thorax showed an
extensive mediastinal soft tissue mass consistent with FM. Pulmonary
angiography demonstrated pulmonary artery stenosis on the right side
and pulmonary vein stenosis mainly on the left side. After measurement
of the pulmonary arterial pressure by right heart catheterization, the
patient was diagnosed with pulmonary hypertension associated with FM.
He underwent balloon angioplasty and stent implantation of the
stenosed pulmonary vessels, which led to long-term improvement in his
breathlessness and pleural effusion. Our systematic review of the
literature highlights that pleural effusion can be an uncommon
complication of FM and requires careful etiological
differentiation.
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Affiliation(s)
- Suqiao Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Jianfeng Wang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jifeng Li
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Yuanhua Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
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7
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Allard-Chamard H, Alsufyani F, Kaneko N, Xing K, Perugino C, Mahajan VS, Wheat JL, Deepe GS, Loyd J, Pillai S. CD4 +CTLs in Fibrosing Mediastinitis Linked to Histoplasma capsulatum. THE JOURNAL OF IMMUNOLOGY 2020; 206:524-530. [PMID: 33328214 DOI: 10.4049/jimmunol.2000433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/13/2020] [Indexed: 12/24/2022]
Abstract
Although fibrotic disorders are frequently assumed to be linked to TH2 cells, quantitative tissue interrogation studies have rarely been performed to establish this link and certainly many fibrotic diseases do not fall within the type 2/allergic disease spectrum. We have previously linked two human autoimmune fibrotic diseases, IgG4-related disease and systemic sclerosis, to the clonal expansion and lesional accumulation of CD4+CTLs. In both these diseases TH2 cell accumulation was found to be sparse. Fibrosing mediastinitis linked to Histoplasma capsulatum infection histologically resembles IgG4-related disease in terms of the inflammatory infiltrate and fibrosis, and it provides an example of a fibrotic disease of infectious origin in which the potentially profibrotic T cells may be induced and reactivated by fungal Ags. We show in this study that, in this human disease, CD4+CTLs accumulate in the blood, are clonally expanded, infiltrate into disease lesions, and can be reactivated in vitro by H. capsulatum Ags. TH2 cells are relatively sparse at lesional sites. These studies support a general role for CD4+CTLs in inflammatory fibrosis and suggest that fibrosing mediastinitis is an Ag-driven disease that may provide important mechanistic insights into the pathogenesis of idiopathic fibrotic diseases.
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Affiliation(s)
- Hugues Allard-Chamard
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139.,Division de Rhumatologie, Faculté de Médecine et des Sciences de la Santé de l'Université de Sherbrooke et Centre de Recherche Clinique Étienne-Le Bel, Sherbrooke, Québec J1K 2R1, Canada
| | - Faisal Alsufyani
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139.,King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
| | - Naoki Kaneko
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139.,Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka 814-0133, Japan
| | - Kelly Xing
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139
| | - Cory Perugino
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139.,Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA 02114
| | - Vinay S Mahajan
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139.,Division of Pathology, Brigham and Women's Hospital, Boston, MA 02115
| | | | - George S Deepe
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH 45267; and
| | - James Loyd
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Shiv Pillai
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139;
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8
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Abstract
PURPOSE OF REVIEW Pulmonary vein stenosis (PVS) is a rare entity that until the last 2 decades was seen primarily in infants and children. Percutaneous and surgical interventions have limited success due to relentless restenosis, and mortality remains high. In adults, acquired PVS following ablation for atrial fibrillation has emerged as a new syndrome. This work will review these two entities with emphasis on current treatment. RECENT FINDINGS Greater emphasis on understanding and addressing the mechanism of restenosis for congenital PVS has led to the use of drug-eluting stents (DES) and systemic drug therapy to target neo-intimal growth. Frequent reinterventions are positively affecting outcomes. Longer-term outcomes of percutaneous treatment for acquired PVS are emerging. Treatment of congenital PVS continues to be plagued by restenosis. DES show promise, but frequent reinterventions are required. Larger upstream vein diameter predicts success for congenital and acquired PVS interventions. Efforts to induce/maintain vessel growth are important for future treatment strategies.
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Affiliation(s)
- Patcharapong Suntharos
- Division of Pediatric Cardiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
| | - Lourdes R Prieto
- Division of Pediatric Cardiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA.
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9
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Duan Y, Zhou X, Su H, Jiang K, Wu W, Pan X, Qi G, Zhang Y, Cao Y. Balloon angioplasty or stent implantation for pulmonary vein stenosis caused by fibrosing mediastinitis: a systematic review. Cardiovasc Diagn Ther 2019; 9:520-528. [PMID: 31737523 DOI: 10.21037/cdt.2019.09.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fibrosing mediastinitis (FM) is a very rare disease, often caused by histoplasmosis capsulatum, tuberculosis, sarcoidosis, autoimmunity and other diseases, such as IgG 4-related diseases. Fibrous structures in the mediastinum compress the pulmonary artery, pulmonary vein, superior vena cava, esophagus, trachea and cardiac vessels, leading to clinical symptoms. Drug therapeutic modality for pulmonary vein stenosis (PVS) caused by FM is palliative in essence and with limited efficacy, whereas surgical treatment causes high mortality. In recent years, catheter-based treatment to FM-caused PVS has emerged as a promising therapeutic modality, however, the safety and effectiveness of this modality remain unclear. Therefore, a systematic review on the safety and efficacy of the catheter-based treatment for PVS caused by FM was performed, in the hope to shed lights on the alternative therapeutic strategy to this fatal disease.
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Affiliation(s)
- Yichao Duan
- Clinical Medicine School, Ningxia Medical University, Yinchuan 750004, China.,Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Xing Zhou
- Department of Radiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Hongling Su
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Kaiyu Jiang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Wenyu Wu
- Clinical Medicine School, Ningxia Medical University, Yinchuan 750004, China.,Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Xin Pan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200000, China
| | - Guanming Qi
- Department of Pulmonary, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yan Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Medical University Eye Hospital, School of Optometry and Ophthalmology & Eye Institute, Tianjin 300384, China
| | - Yunshan Cao
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
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10
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Fender EA, Widmer RJ, Knavel Koepsel EM, Welby JP, Kern R, Peikert T, Bjarnason H, Holmes DR. Catheter based treatments for fibrosing mediastinitis. Catheter Cardiovasc Interv 2019; 94:878-885. [PMID: 30790443 DOI: 10.1002/ccd.28152] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 11/07/2022]
Abstract
Fibrosing mediastinitis is a rare, often debilitating and potentially lethal disease characterized by an exuberant fibroinflammatory response within the mediastinum. Patients typically present with insidious symptoms related to compression of adjacent structures including the esophagus, heart, airways, and cardiac vessels. Fibrosing mediastinitis is most often triggered by Histoplasmosis infection; however, antifungal and anti-inflammatory therapies are largely ineffective. While structural interventions aimed at alleviating obstruction can provide significant palliation, surgical interventions are challenging with high mortality and clinical experience with percutaneous interventions is limited. Here, we will review the presentation, natural history, and treatment of fibrosing mediastinitis, placing particular emphasis on catheter-based therapies.
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Affiliation(s)
- Erin A Fender
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - R Jay Widmer
- Department of Cardiovascular Diseases, Baylor Scott and White, Temple, Texas
| | | | - John P Welby
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ryan Kern
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tobias Peikert
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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11
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Recurrent Pneumonia due to Fibrosing Mediastinitis in a Teenage Girl: A Case Report with Long-Term Follow-Up. Case Rep Pediatr 2018; 2018:3246929. [PMID: 29744231 PMCID: PMC5878908 DOI: 10.1155/2018/3246929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/19/2018] [Indexed: 11/18/2022] Open
Abstract
A teenage girl was evaluated for recurrent right pneumonia. The evaluation revealed a calcified mediastinal mass that compressed the right intermediate and middle lobar bronchi, as well as the right pulmonary artery and veins. The clinical picture together with imaging studies and borderline positive serology testing suggested a diagnosis of fibrosing mediastinitis associated with histoplasmosis. This rare condition is characterized by the local proliferation of invasive fibrous tissue within the mediastinum due to a hyperimmune reaction to Histoplasma capsulatum. Antifungal and anti-inflammatory therapies are usually ineffective, and surgical intervention contains a high morbidity risk. Palliative surgery and stenting of the compressed airway have been suggested. In the past, the prognosis was thought to be poor, but recent studies demonstrate a more positive outcome. Our patient had been radiologically and functionally stable under follow-up for over thirteen years and has married and delivered two healthy children, both following an uneventful pregnancy.
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