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Dong S, Dai X, Jiang Y, Zheng J. Idiopathic fibrous mediastinitis with refractory pleural effusion: a case report and literature review. J Int Med Res 2021; 49:3000605211040264. [PMID: 34459275 PMCID: PMC8408902 DOI: 10.1177/03000605211040264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fibrous mediastinitis is a rare progressive disease characterized by invasive proliferation of fibrous tissue in the mediastinum. This tissue proliferation leads to compression of the mediastinal structures in the thoracic cavity, including the pulmonary vessels, esophagus, and trachea, causing corresponding symptoms and complications such as pulmonary hypertension. In clinical practice, the diagnosis of fibrous mediastinitis is often delayed or missed because of the rarity and variable clinical manifestations of this condition. This article presents a case of idiopathic fibrous mediastinitis that manifested as pleural effusion of unknown etiology along with a review of the relevant literature.
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Affiliation(s)
- Shuangxia Dong
- Department of Respiratory, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xinjian Dai
- Department of Respiratory, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yi Jiang
- Department of Pathology, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jiyang Zheng
- Department of Respiratory, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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2
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Abstract
Fibrosing mediastinitis is rare in settings where histoplasmosis is not endemic. An idiopathic form of the disease may present with
indistinguishable features and requires methodical exclusion of competing differential diagnoses. We report the case of a 30-year old female
patient who presented with intermittent haemoptysis for the past 2 years with no constitutional symptoms. Computed tomography of the
chest revealed a prominent right bronchial arterial circulation with a mass-like lesion, which encased and attenuated the right pulmonary
trunk and adjacent structures. Endobronchial ultrasonography with transbronchial fine-needle aspiration showed a paucicellular aspirate
with no evidence of malignancy or granulomas. Fungal infection, tuberculosis, sarcoidosis, IgG4-disease, and connective tissue disease were
ruled out by appropriate serological, molecular, and microbiological tests. A diagnosis of idiopathic fibrosing mediastinitis was therefore
made by exclusion and the patient was successfully treated with oral corticosteroids.
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3
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Ahmed S, Hameed M, Thomas MM, Syed KS, Haq IU, AlAbbas A. Ptosis and Miosis Associated with Fibrosing Mediastinitis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927556. [PMID: 33431787 PMCID: PMC7811979 DOI: 10.12659/ajcr.927556] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fibrosing mediastinitis is a rarely seen, progressive disease. It results from an excessive fibrotic reaction in the mediastinum. We describe a presentation of fibrosing mediastinitis that, to our knowledge, has never been seen before. CASE REPORT A 30-year-old female Colombian flight attendant presented with a right eyelid droop. Examination revealed partial right-sided ptosis and miosis but no anhidrosis. An ill-defined firm swelling was palpable at the root of the neck. Chest radiography revealed a widened mediastinum, and computerized tomography (CT) showed a right paratracheal mass without calcification extending to the thoracic inlet, encasing multiple blood vessels. All basic blood tests, magnetic resonance imaging of the head, and ultrasound Doppler of the neck vessels were normal. History and work up for infections including fungal diseases, granulomatous diseases, vasculitis, and autoimmune diseases were negative. Positron emission tomography (PET) showed significant FDG uptake in the mediastinum. Mediastinal biopsy was histologically consistent with fibrosing mediastinitis. All relevant immunohistochemistry and microbiological studies were negative. Subsequently, the patient developed signs of superior vena cava compression; this was managed by balloon angioplasty, which resulted in improvement of symptoms. However, over time, her symptoms worsened progressively, resulting in a left-sided ptosis and radiological progression of the mass on CT. She received treatment with rituximab and concomitant steroids, which yielded excellent results: the treatment led to both resolution of her symptoms and regression of the mass and its metabolic activity on PET scan. CONCLUSIONS Fibrosing mediastinitis can present with an incomplete Horner's syndrome. Treatment with rituximab and steroids shows promising results in select cases of metabolically active idiopathic fibrosing mediastinitis.
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Affiliation(s)
- Shakeel Ahmed
- Department of Pulmonary Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mansoor Hameed
- Department of Pulmonary Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Merlin M Thomas
- Department of Pulmonary Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Khezar S Syed
- Department of Pulmonary Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Irfan U Haq
- Department of Pulmonary Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abbas AlAbbas
- Department of Pulmonary Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Successful management of fibrosing mediastinitis with severe vascular compromise: Report of two cases and literature review. Respir Med Case Rep 2019; 29:100987. [PMID: 31890562 PMCID: PMC6928374 DOI: 10.1016/j.rmcr.2019.100987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 01/08/2023] Open
Abstract
Fibrosing mediastinitis is a rare disorder characterized by the invasive proliferation of fibrous tissue within the mediastinum. This fibrosis can result in compression of intrathoracic structures including the pulmonary vasculature leading to clinical symptoms and complications like pulmonary hypertension. Here, we present two cases of young patients with fibrosing mediastinitis complicated by pulmonary artery stenosis requiring medical and endovascular management with excellent results.
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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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