Focused review


Fibrosing Mediastinitis

Tatiana Denega MD, Hawa Edriss MD, David Sotello MD, Kenneth Nugent MD

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.

Keywords: fibrosing mediastinitis, venous stenosis, arterial stenosis, tracheal/bronchial stenosis




Article citation: Denega T, Edriss H, Sotello D, Nugent K. Fibrosing Mediastinitis. The Southwest Respiratory and Critical care chronicles 2017;5(21):4–10

From: Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX

Submitted: 8/7/2017

Accepted: 10/3/2017

Reviewer: Anoop Nambiar MD

Conflicts of interest: none