Fibrosing Mediastinitis

  • Tatiana Denega Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX
  • Hawa Edriss Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX
  • David Sotello Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX
  • Kenneth Nugent Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX
Keywords: fibrosing mediastinitis, venous stenosis, arterial stenosis, tracheal/bronchial stenosis

Abstract

Fibrosing mediastinitis is an uncommon thoracic disorder characterized by the extensive
proliferation of fibrous tissue in the mediastinum. This disorder frequently develops following
Histoplasma capsulatum infection with involvement of mediastinal lymph nodes. The fibrous
tissue can invade and compress mediastinal structures, including vessels, large airways, and
the esophagus. These patients may present with cough, sputum production, and dyspnea
depending on location and extent of fibrosis. The radiographic presentation depends on the
type and extent of obstruction. Diagnosis requires computed tomography with angiography,
ventilation-perfusion scans, and pulmonary function tests. Management depends on the
structures involved and the extent of infiltration and/or compression. Possible approaches
include the use of endobronchial stents, intravascular stents, vascular bypass grafts, and
the resection of nonfunctional pulmonary tissue. Extensive surgical procedures are usually
not warranted. These patients usually do not respond to antifungal or anti-inflammatory
medications. Several patients have responded to rituximab, and this drug is a possible
consideration in patients with ongoing inflammation in the mediastinum.

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Published
2017-10-16
How to Cite
Denega, T., Edriss, H., Sotello, D., & Nugent, K. (2017). Fibrosing Mediastinitis. The Southwest Respiratory and Critical Care Chronicles, 5(21), 4-10. https://doi.org/10.12746/swrccc.v5i21.419