1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Yang J, Deng L, Jing M, Xu M, Liu X, Li S, Zhang L, Xi H, Yuan L, Zhou J. Added value of spectral computed tomography quantitative parameters for differentiating tuberculosis-associated fibrosing mediastinitis from endobronchial lung cancer: initial results. Clin Radiol 2024; 79:526-535. [PMID: 38658213 DOI: 10.1016/j.crad.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The objective of this study was to explore the added value of spectral computed tomography (CT) parameters to conventional CT features for differentiating tuberculosis-associated fibrosing mediastinitis (TB-associated FM) from endobronchial lung cancer (EBLC). METHODS Chest spectral CT enhancement images from 109 patients with atelectasis were analyzed retrospectively. These patients were divided into two distinct categories: the TB-associated FM group (n = 77) and the EBLC group (n = 32), based on bronchoscopy and/or pathological findings. The selection of spectrum parameters was optimized with the least absolute shrinkage and selection operator regression analysis. The relationship between the spectrum parameters and conventional parameters was explored using Pearson's correlation. Multivariate logistic regression analysis was used to build spectrum model. The spectrum parameters in the spectrum model were replaced with their corresponding conventional parameters to build the conventional model. Diagnostic performances were evaluated using receiver operating characteristic curve analyses. RESULTS There was a moderate correlation between the parameters ㏒(L-AEFNIC) - ㏒(L-AEFC) (r= 0.419; p< 0.0001), ㏒(O-AEF40KeV) - ㏒(O-AEFC) (r= 0.475; p< 0.0001), [L-A-hydroxyapatite {HAP}(I)] - (L-U-CT) (r= 0.604; p< 0.0001), {arterial enhancement fraction (AEF) derived from normalized iodine concentration (NIC) of lymph node (L-AEFNIC), AEF derived from CT40KeV of bronchial obstruction (O-AEF40KeV), arterial-phase Hydroxyapatite (Iodine) concentration of lymph node [L-A-HAP(I)], AEF derived from conventional CT (AEFC), unenhanced CT value (U-CT)}. Spectrum model could improve diagnostic performances compared to conventional model (area under curve: 0.965 vs 0.916, p= 0.038). CONCLUSION There was a moderate correlation between spectrum parameters and conventional parameters. Integrating conventional CT features with spectrum parameters could further improve the ability in differentiating TB-associated FM from EBLC.
Collapse
Affiliation(s)
- J Yang
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
| | - L Deng
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
| | - M Jing
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
| | - M Xu
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
| | - X Liu
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
| | - S Li
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
| | - L Zhang
- Zhang Ye People's Hospital Affiliated to Hexi University, Zhangye, 73400, China.
| | - H Xi
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
| | - L Yuan
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
| | - J Zhou
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, China.
| |
Collapse
|
3
|
Li B, Zhu H, Jia M, Song J, Carl T, Koybasi G, Qi G, Su H, Cao Y. Venous retrograde approach for endovascular angioplasty in chronic total pulmonary vein occlusion -a case report. BMC Cardiovasc Disord 2024; 24:315. [PMID: 38909188 PMCID: PMC11193303 DOI: 10.1186/s12872-024-03984-y] [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: 10/25/2023] [Accepted: 06/17/2024] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Fibrosing mediastinitis (FM) is a rare disease characterized by excessive proliferation of fibrous tissue in the mediastinum and can cause bronchial stenosis, superior vena cava obstruction, pulmonary artery and vein stenosis, etc. CASE PRESENTATION: An aging patient with intermittent chest tightness and shortness of breath was diagnosed with FM associated pulmonary hypertension (FM-PH) by echocardiography and enhanced CT of the chest, and CT pulmonary artery (PA)/ pulmonary vein (PV) imaging revealed PA and PV stenosis. Selective angiography revealed complete occlusion of the right upper PV, and we performed endovascular intervention of the total occluded PV. After failure of the antegrade approach, the angiogram revealed well-developed collaterals of the occluded RSPV-V2b, so we chose to proceed via the retrograde approach. We successfully opened the occluded right upper PV and implanted a stent. CONCLUSIONS This report may provide new management ideas for the interventional treatment of PV occlusion.
Collapse
Affiliation(s)
- Bo Li
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 204 Donggangxi Road, Lanzhou, 730000, P. R. China
| | - Hai Zhu
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 204 Donggangxi Road, Lanzhou, 730000, P. R. China
| | - Mengfei Jia
- The First Clinical Medical College of Gansu, University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, P. R. China
| | - Jinrui Song
- Department of Cardiology, Shengli Oilfield Central Hospital, 31 Jinan Road, Dongying, 257000, Shandong, China
| | - Tanba Carl
- Department of Internal Medicine, Medstar Health, Baltimore, MD, USA
| | - Gizem Koybasi
- Department of Pulmonary Medicine, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Guanming Qi
- Division of Pulmonary, Critical Care and Sleep, Tufts Medical Center, Boston, MA, 02111, USA
| | - Hongling Su
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 204 Donggangxi Road, Lanzhou, 730000, P. R. 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.
| |
Collapse
|
4
|
Chakraborty S, Mukherjee S, Mukherjee A, Chaudhuri M. A 46-year-old woman presenting with anterior mediastinal mass and superior vena cava obstruction syndrome. Breathe (Sheff) 2024; 20:240038. [PMID: 39015656 PMCID: PMC11249840 DOI: 10.1183/20734735.0038-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/02/2024] [Indexed: 07/18/2024] Open
Abstract
Mucormycosis can rarely lead to an anterior mediastinal mass and a high index of suspicion is necessary so that intervention can be carried out at an early stage. https://bit.ly/4aUuqvc.
Collapse
|
5
|
Tang N, Tao T, Bao XL. Endobronchial ultrasound-guided cautery-assisted transbronchial mediastinal cryobiopsy in the diagnosis of fibrosing mediastinitis secondary to atypical sarcoidosis: a case report. AME Case Rep 2024; 8:49. [PMID: 38711901 PMCID: PMC11070980 DOI: 10.21037/acr-23-160] [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: 09/14/2023] [Accepted: 01/25/2024] [Indexed: 05/08/2024]
Abstract
Background Fibrosing mediastinitis (FM) secondary to atypical sarcoidosis (atypical presentation of sarcoidosis) is rarely reported at home and abroad. Its clinical manifestations represent a lack of specificity, and the initial diagnosis is frequently difficult. In particular, this case has multiple pulmonary nodules with mediastinal lymph node enlargement and bilateral pleural effusion, and pulmonary fibrosis still exists after treatment, which is inconsistent with any clinical stage of pulmonary sarcoidosis, further increasing the diagnostic difficulty. We retrospectively analyzed the clinical data of a case of FM secondary to atypical sarcoidosis diagnosed by endobronchial ultrasound-guided cautery-assisted transbronchial mediastinal cryobiopsy (EBUS-CA-TBMCB) in Chongqing University Fuling Hospital, to improve clinicians' attention to FM and understand that EBUS-CA-TBMCB remains an effective way of etiological diagnosis. Case Description A 70-year-old man was hospitalized with cough and dyspnea for two months. After admission, through chest computed tomography (CT), ultrasound guided bilateral lung biopsy, left parietal pleural biopsy, and EBUS-CA-TBMCB, the final diagnosis was atypical sarcoidosis secondary FM. After taking glucocorticoid orally, the patient's condition improved significantly, and was discharged from the hospital. We continued following up outside the hospital, and the patient's condition was further improved. Conclusions The diagnosis of FM is mainly based on typical imaging manifestations. When the contrast-enhanced chest CT finds localized or diffuse soft tissue density shadows around the mediastinum and pulmonary hilum with an irregular shape, with or without calcification, particular attention should be paid to exclude FM. EBUS-CA-TBMCB, as an improved minimally invasive method, can obtain enough tissue samples for pathological diagnosis, which may be the effective biopsy method for the etiology of FM to avoid missed diagnosis and misdiagnosis in the future.
Collapse
Affiliation(s)
- Nan Tang
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, China
| | - Tao Tao
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, China
| | - Xiao-Li Bao
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, China
| |
Collapse
|
6
|
Wang Y, Bu C, Zhang M, Wang J, Jiang K, Ding M, Su H, Long X, Jia M, Li Y, Cao Y. Pulmonary vascular stenosis scoring in fibrosing mediastinitis. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae034. [PMID: 39045195 PMCID: PMC11195784 DOI: 10.1093/ehjimp/qyae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/23/2024] [Indexed: 07/25/2024]
Abstract
Aims This study aims to develop a scoring system for evaluating the degree of pulmonary vascular stenosis in fibrosing mediastinitis (FM). Methods and results A retrospective single-centre study was conducted on 56 patients with FM in China between April 2014 and August 2021. The involvement of pulmonary vessels in patients with FM was assessed using dual-phase computed tomography pulmonary angiography, and we found that 85.7% of the patients had both pulmonary artery (PA) and vein (PV) involvement. PA involvement was mainly located proximal to both the upper PA and the bilateral basal trunk levels in the lower lungs. The involvement of the superior PV was more common than that of the inferior PV, and the right inferior PV was the least involved. Most of these lesions exhibited moderate or severe stenosis. Additionally, a scoring system for evaluating the degree of pulmonary vascular stenosis was developed. A correlation analysis revealed a negative correlation between the final pulmonary vascular score and the pulmonary arterial pressure, pulmonary vascular resistance, and maximum tricuspid regurgitation velocity. The calculated score of 17.1 was the best cut-off value for the diagnosis of mild and severe pulmonary hypertension (PH). Conclusion We successfully developed a scoring system for pulmonary vascular stenosis that can be used to evaluate the severity of pulmonary vessel involvement and PH. This scoring system may be relevant in the future development of target-based strategies for percutaneous interventions.
Collapse
Affiliation(s)
- Yangyang Wang
- School of Clinical Medicine, Ningxia Medical University, No. 1160, Shengli Street, Yinchuan 750004, China
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Chao Bu
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628, Zhenyuan Road, Xinhu Street, Shenzhen 518107, China
| | - Mengdi Zhang
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628, Zhenyuan Road, Xinhu Street, Shenzhen 518107, China
| | - Juan Wang
- School of Clinical Medicine, Ningxia Medical University, No. 1160, Shengli Street, Yinchuan 750004, China
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Kaiyu Jiang
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Mingwang Ding
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), No. 35, Dingxi East Road, Lanzhou 730000, China
| | - Hongling Su
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Xiaozhou Long
- Department of Radiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
| | - Mengfei Jia
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), No. 35, Dingxi East Road, Lanzhou 730000, China
| | - Yu Li
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628, Zhenyuan Road, Xinhu Street, Shenzhen 518107, China
| | - Yunshan Cao
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, China
- Heart, Lung and Vessels Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 32, West Second Section, Yihuan Road, Qingyang District, Chengdu 610072, China
| |
Collapse
|
7
|
Ezzahi M, Ennasery Z, Malih SE, Akammar A, Bouardi NE, Haloua M, Alaoui Lamrani MY, Boubbou M, Serraj M, Maaroufi M, Smahi M, Bouchra A, Alami B. Mediastinal fibrosis as a late and fatal complication of treated tuberculosis mimicking a neoplastic process in a 34-year-old man. Radiol Case Rep 2023; 18:4287-4293. [PMID: 37771381 PMCID: PMC10522869 DOI: 10.1016/j.radcr.2023.09.001] [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: 07/30/2023] [Revised: 08/27/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
Fibrosing mediastinitis, also known as sclerosing mediastinitis, is an uncommon condition marked by abnormal proliferation of fibrous tissue in the mediastinum. This condition may accrue either as an idiopathic condition or as a complication of an underlying disease process. Its pathogenesis remains unknown. However, most reported cases are incriminating abnormal immune-mediated hypersensitivity responses to Histoplasma infection. Other rare causes include tuberculosis, blastomycosis, and an idiopathic form that may be associated with other miscellaneous conditions. CT and MR imaging play a vital role in the diagnosis and management of this disease. We present a rare case of fibrosing mediastinitis as a late complication of tuberculosis in a 34-year-old man with a prior history of mediastinal tuberculosis, mimicking initially a neoplastic mediastinal process. We will describe this clinical case in the light of the literature and point out the contribution of radiological imaging in the diagnosis of this rare pathology.
Collapse
Affiliation(s)
- Manar Ezzahi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Zaid Ennasery
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Sara El Malih
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Amal Akammar
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Nizar El Bouardi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Meriem Haloua
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Moulay Youssef Alaoui Lamrani
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Meryem Boubbou
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Mounia Serraj
- Department of Pneumology - CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Mustapha Maaroufi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Mohamed Smahi
- Department of Thoracic Surgery - CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Amara Bouchra
- Department of Pneumology - CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Badreeddine Alami
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| |
Collapse
|
8
|
Zhou M, Li B, Chen Y, Wang A, Zhu Y, Li Y, Su H, Fan J, Zhang Y, Cao Y. Chest X-ray features facilitate screening for pulmonary hypertension caused by fibrosing mediastinitis. Ther Adv Chronic Dis 2022; 13:20406223221143245. [PMID: 36583160 PMCID: PMC9793020 DOI: 10.1177/20406223221143245] [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: 07/20/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background Misdiagnosis and underdiagnosis of pulmonary hypertension caused by fibrosing mediastinitis (PH-FM) are considerably prevalent due to unspecific symptoms and as well as the lack of awareness of this fatal disease. Objectives The aim of this study was to evaluate the diagnostic accuracy of the chest X-ray (CXR) for screening the patients with PH-FM from those with pulmonary hypertension (PH). Design This was a retrospective observational cohort study. Methods The patients with suspected PH were recruited between October 2014 and October 2020. All the clinical data and CXR findings were collected. The sensitivity, specificity, and likelihood ratio of the CXR features were calculated. Logistic regression was used to identify the factors associated with the CXR characteristics and FM and to generate a prediction model. Finally, the diagnostic efficiency of the prediction model was evaluated using nomogram and internal validation. Results The patients with PH-FM (n = 36) and PH caused by the diseases other than FM (PH-non-FM, n = 62) were enrolled. The CXR features, including atelectasis, pleural effusion, consolidation, nodules, calcification, interlobular septal thickening, and interstitial reticulation, were more prevalent in patients with PH-FM than in those with PH-non-FM (all p < 0.05). Atelectasis had a specificity of 97%, a sensitivity of 50%, and a greater accuracy for diagnosing of PH-FM [area under the curve (AUC) = 0.720; 95% CI: 0.634-0.806] than the other factors did. The combination of tuberculosis, natural logarithmic NT-proBNP (lnBNP), atelectasis, pleural effusion, and prominent right heart border constituted a prediction model to distinguish the PH-FM from the PH-non-FM, with a sensitivity of 91.7% and a specificity of 83.9%. The model demonstrated good prediction performance by showing an AUC of 0.922 (95% CI: 0.861-0.983) in the internal validation. Conclusion In this study, atelectasis was the most specific and accurate CXR characteristic for identifying PH-FM in the PH patients. The combination of atelectasis, pleural effusion, prominent right heart border, tuberculosis, and lnBNP constituted a prediction model that distinguished the PH-FM patients from the PH-non-FM ones with good performance.
Collapse
Affiliation(s)
| | | | - Yaling Chen
- The First Clinical Medical College of Gansu
University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou,
China
| | - Aqian Wang
- Department of Cardiology, Pulmonary Vascular
Disease Center (PVDC), Gansu Provincial Hospital, Lanzhou, China
| | - Yining Zhu
- School of Mathematical Sciences, Fudan
University, Shanghai, China
| | - Yu Li
- Department of Radiology, The Seventh Affiliated
Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hongling Su
- Department of Cardiology, Pulmonary Vascular
Disease Center (PVDC), Gansu Provincial Hospital, Lanzhou, China
| | - Jingchun Fan
- Gansu University of Chinese Medicine, Lanzhou,
China
| | | | | |
Collapse
|
9
|
Wang A, Su H, Duan Y, Jiang K, Li Y, Deng M, Long X, Wang H, Zhang M, Zhang Y, Cao Y. Pulmonary Hypertension Caused by Fibrosing Mediastinitis. JACC: ASIA 2022; 2:218-234. [PMID: 36338410 PMCID: PMC9627819 DOI: 10.1016/j.jacasi.2021.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022]
Abstract
Pulmonary hypertension (PH) is a progressive and severe disorder in pulmonary hemodynamics. PH can be fatal if not well managed. Fibrosing mediastinitis (FM) is a rare and benign fibroproliferative disease in the mediastinum, which may lead to pulmonary vessel compression and PH. PH caused by FM (PH-FM) is a pathologic condition belonging to group 5 in the World Health Organization PH classification. PH-FM has a poor prognosis because of a lack of effective therapeutic modalities and inappropriate diagnosis. With the development of percutaneous pulmonary vascular interventional therapy, the prognosis of PH-FM has been greatly improved in recent years. This article provides a comprehensive review on the epidemiology, pathophysiologic characteristics, clinical manifestations, diagnostic approaches, and treatment modalities of PH-FM based on data from published reports and our medical center with the goal of facilitating the diagnosis and treatment of this fatal disease. PH-FM, as a type of rare condition in group 5 PH, has a poor prognosis because of a lack of effective therapeutic modalities and frequent misdiagnosis and underdiagnosis. The most prevalent trigger of FM is H-FM in the United States and TB-FM in China. Imaging findings, including mismatched perfusion defects in the V/Q scan, FM dyad, and FM triad are important diagnostic clues, and clinical classification facilitates decision making in diagnosis and therapeutics. Because of the limited efficacy of drug therapy as well as the uncertain effectiveness and high risk of surgical treatment, endovascular interventional modality is currently the preferred therapeutic option, although procedure-related complications and intrastent restenosis after PV intervention need to be addressed.
Collapse
|
10
|
Zhang X, Zhang S, Wang J, Jiang W, Sun L, Li Y, Guo D, Yang Y, Lu X, Li Y. Comparison of fibrosing mediastinitis patients with vs. without markedly increased systolic pulmonary arterial pressure: a single-center retrospective study. BMC Cardiovasc Disord 2022; 22:134. [PMID: 35361126 PMCID: PMC8973553 DOI: 10.1186/s12872-022-02567-z] [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: 11/18/2021] [Accepted: 03/14/2022] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Fibrosing mediastinitis (FM) complicated with pulmonary hypertension (PH) has been considered as an important cause of morbidity and mortality. This study was designed to observe the possible effects of abnormal hemodynamics on patients by conducting a between-group comparison according to the presence of markedly increased systolic pulmonary arterial pressure (SPAP), so as to provide more information for clinical management. MATERIALS AND METHODS Fifty-one patients with clinically diagnosed FM were divided in two groups (SPAP < 50 mmHg group; SPAP ≥ 50 mmHg group) and retrospectively included in the study. Data mainly including demographic factors, echocardiographic data, results of right heart catheter and computed tomography (CT) examination were retrieved from the medical database. Echocardiographic parameters pre- and post- balloon pulmonary angioplasty (BPA) treatment were also collected in 8 patients. RESULTS Significant changes in cardiac structure, hemodynamics and cardiac function were detected in patients complicated with markedly increased SPAP. Patients in the SPAP ≥ 50 mmHg group had increased right heart diameter, right heart ratio and velocity of tricuspid regurgitation (VTR) (p < 0.05). Deteriorated right heart function was also observed. There was no significant difference in CT findings between the two groups, except that more patients in the SPAP ≥ 50 mmHg group had pleural effusion (p < 0.05). After primary BPA in 8 patients, improvement in the right atrium proportion was observed. CONCLUSIONS Changes due to significantly increased SPAP in patients with FM include adverse structure and function of the right heart, but differences in CT findings were not significant. Echocardiography has advantages as a noninvasive tool for the evaluation of cardiac structure, function and hemodynamics in patients with FM.
Collapse
Affiliation(s)
- Xinyuan Zhang
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Shu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jianfeng Wang
- Department of Intervention, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wei Jiang
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Lanlan Sun
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yuanzhi Li
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Dichen Guo
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yidan Li
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| |
Collapse
|
11
|
Kobayashi Y, Ishiguro T, Takaku Y, Kagiyama N, Shimizu Y, Takayanagi N. Clinical Features of Fibrosing Mediastinitis in Japanese Patients: Two Case Reports and a Literature Review. Intern Med 2021; 60:3765-3772. [PMID: 34024847 PMCID: PMC8710366 DOI: 10.2169/internalmedicine.5737-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/01/2020] [Indexed: 12/02/2022] Open
Abstract
Fibrosing mediastinitis (FM) is a rare fibroinflammatory disease of the mediastinum with an etiology and clinical features that vary by world region. The characteristics of FM in Japan are still unknown. We herein report two Japanese patients with FM who were treated with corticosteroids and responded well. We also reviewed the Japanese literature on PubMed® and summarized the characteristics of 27 Japanese FM patients, including our two patients. In Japan, the predominant cases were those without a specific cause, were diffusely distributed, and responded well to corticosteroid therapy.
Collapse
Affiliation(s)
- Yoichi Kobayashi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yotaro Takaku
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Naho Kagiyama
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yoshihiko Shimizu
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| |
Collapse
|
12
|
Garin A, Chassagnon G, Tual A, Revel MP. CT features of fibrosing mediastinitis. Diagn Interv Imaging 2021; 102:759-762. [PMID: 34167927 DOI: 10.1016/j.diii.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alexandre Garin
- Department of Radiology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France.
| | - Guillaume Chassagnon
- Department of Radiology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Arnaud Tual
- Department of Radiology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Abstract
ABSTRACT Mycobacterium infection remains a leading cause of morbidity and mortality worldwide. Although rare, thoracic cardiovascular complications are associated with devastating consequences if not promptly diagnosed using computed tomography. Intrapulmonary complications include tuberculous aortitis, Rasmussen aneurysms, involvement of bronchial and nonbronchial systemic arteries, and thromboembolic events. Extrapulmonary complications include pericarditis, myocarditis, endocarditis, involvement of coronary arteries, annular-subvalvular left ventricle aneurysms and mediastinal fibrosis. This article will review these complications and their computed tomography features.
Collapse
|
15
|
Vaideeswar P, Chaudhari J, Goel N. Fungal fibrosing mediastinitis in pregnancy - Case report with review of literature. J Postgrad Med 2020; 65:52-55. [PMID: 30693874 PMCID: PMC6380127 DOI: 10.4103/jpgm.jpgm_358_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fibrosing mediastinitis (FM) is characterized by extensive and invasive fibro-inflammatory proliferation, triggered by a delayed hypersensitivity reaction to variety of infective or noninfective stimuli. The infective agents often have a geographic distribution such as Histoplasma capsulatum in North America and Mycobacterium tuberculosis in Asian regions. In few reports, the mediastinitis is caused by fungi, particularly Aspergillus species. We report the first case of possible aspergillous FM in a young pregnant woman.
Collapse
Affiliation(s)
- P Vaideeswar
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - J Chaudhari
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Goel
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
16
|
Gothi D, Datta A, Patro M. Mediastinal mass mimic. Lung India 2020; 37:66-68. [PMID: 31898624 PMCID: PMC6961108 DOI: 10.4103/lungindia.lungindia_124_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
17
|
Narechania S, Renapurkar R, Heresi GA. Mimickers of chronic thromboembolic pulmonary hypertension on imaging tests: a review. Pulm Circ 2020; 10:2045894019882620. [PMID: 32257112 PMCID: PMC7103595 DOI: 10.1177/2045894019882620] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/21/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by mechanical obstruction of large pulmonary arteries secondary to one or more episodes of pulmonary embolism. Ventilation perfusion scan is the recommended initial screening test for this condition and typically shows multiple large mismatched perfusion defects. However, not all patients with an abnormal ventilation perfusion scan have CTEPH since there are other conditions that be associated with a positive ventilation perfusion scan. These conditions include in situ thrombosis, pulmonary artery sarcoma, fibrosing mediastinitis, pulmonary vasculitis and sarcoidosis, among others. Although these conditions cannot be distinguished from CTEPH using a ventilation perfusion scan, they have certain characteristic radiological features that can be demonstrated on other imaging techniques such as computed tomography scan and can help in differentiation of these conditions. In this review, we have summarized some key clinical and radiological features that can help differentiate CTEPH from the CTEPH mimics.
Collapse
Affiliation(s)
| | - Rahul Renapurkar
- Department of Diagnostic Radiology,
Cleveland
Clinic, Cleveland, OH, USA
| | | |
Collapse
|
18
|
Gao WW, Zhang X, Fu ZH, Hu WY, Zhang XR, Dai GC, Zeng Y. Tuberculosis mediastinal fibrosis misdiagnosed as chronic bronchitis for 10 years: a case report. Quant Imaging Med Surg 2019; 9:1179-1183. [PMID: 31367572 DOI: 10.21037/qims.2019.06.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Wei-Wei Gao
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Xia Zhang
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Zhi-Hao Fu
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Wei-Yi Hu
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Xiang-Rong Zhang
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Guang-Chuan Dai
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Yi Zeng
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| |
Collapse
|
19
|
Kavurmacı Ö, Akçam Tİ, Ergönül AG, Turhan K. İdiyopatik mediastinal fibrozis. EGE TIP DERGISI 2018. [DOI: 10.19161/etd.414700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|