Sclerosing mediastinitis in a smoker with suspected lung cancer

Published on Jan 1, 2010in Respiratory Medicine Cme
· DOI :10.1016/J.RMEDC.2009.09.025
Kathryn Bateman1
Estimated H-index: 1
(Southmead Hospital),
Anoop Chauhan13
Estimated H-index: 13
(QA: Queen Alexandra Hospital)
+ 1 AuthorsDavid Weedon1
Estimated H-index: 1
(Southampton General Hospital)
A case history is presented of a middle-age patient with a rare cause of haemoptysis presenting as a pulmonary mass associated with mediastinal lymphadenopathy. Surgical resection demonstrated sclerosing (or fibrosing) mediastinitis, a condition uncommon outside areas of endemic fungal infection. We describe a case whereby an FDG-PET scan showed avid uptake of signal highly suspicious of cancer.
#1Koei Ikeda (Kumamoto University)H-Index: 17
#2Hiroaki Nomori (Kumamoto University)H-Index: 40
Last. Masakazu Yoshioka (Kumamoto University)H-Index: 12
view all 7 authors...
The use of steroids to successfully treat a 75-year-old woman with fibrosing mediastinitis and sclerosing cervicitis causing a stricture of the left common carotid artery is reported. Biopsy specimens showed collagenous fibers and fibroblasts with moderate infiltration of lymphocytes. The mediastinal and neck lesions were significantly reduced, with almost complete resolution of arterial stricture, 3 months after initiating administration of prednisolone at 20 mg/d.
21 CitationsSource
#1Hideo Ichimura (University of Tsukuba)H-Index: 9
#2Shigemi Ishikawa (University of Tsukuba)H-Index: 16
Last. Yuzuru Sakakibara (University of Tsukuba)H-Index: 17
view all 7 authors...
A 65-year-old woman was referred to our department for investigation and treatment of hoarseness. A chest computed tomography (CT) scan showed a mediastinal mass spreading into the aortopulmonary window. This finding and that of flexible laryngoscopy suggested that the hoarseness was being caused by left recurrent nerve involvement resulting in left vocal cord paralysis. Thus, we performed a mediastinoscopic biopsy via a parasternal incision. Pathological examination revealed dense fibrous tissu...
13 CitationsSource
#1S t DechambreH-Index: 1
#2Dorzée JH-Index: 1
Last. J.P. D’OdemontH-Index: 2
view all 6 authors...
The side-effects of radiation therapy on the bronchial tree or on the mediastinum are seldom reported. In this setting, we report a case of sclerosing mediastinitis with bronchial stenosis discovered 1 yr after external radiotherapy for lung cancer. The patient was treated with a Dumont stent and has so far had an uneventful further course for up to 42 months. Bronchial stenosis related to mediastinal fibrosis after radiotherapy has not been reported previously.
31 CitationsSource
#1T M MoleH-Index: 1
#2J GloverH-Index: 1
Last. M N SheppardH-Index: 1
view all 3 authors...
BACKGROUND--Sclerosing mediastinitis is a rare condition which causes dense fibrosis of the mediastinum. Few large studies have been reported to date. The clinical and pathological features of cases have been studied in a specialist referral centre in the UK. METHODS--The pathological files of the Royal Brompton Hospital were examined and 18 cases of sclerosing mediastinitis were identified between 1970 and 1993. The clinical notes were obtained and the pathological specimens analysed. RESULTS--...
73 CitationsSource
#1Michael T. Flannery (USF: University of South Florida)H-Index: 11
#2Marilin Espino (USF: University of South Florida)H-Index: 1
Last. Paul M. WallachH-Index: 14
view all 5 authors...
: Cases in which fibrotic variants of Hodgkin's disease have been confused with sclerosing mediastinitis have rarely been reported. Sclerosing mediastinitis typically involves the superior/middle mediastinum and, in the United States, is most commonly due to histoplasmosis. We describe the case of a patient who came to us with fevers, a mixed anemia, and a posterior mediastinal mass that on pathologic examination appeared to be due to idiopathic sclerosing mediastinitis. Only inclusion of a biop...
11 CitationsSource
#1Andrew D. Sherrick (UR: University of Rochester)H-Index: 1
#2Larry R. Brown (UR: University of Rochester)H-Index: 1
Last. Jeffrey L. Myers (UR: University of Rochester)H-Index: 6
view all 4 authors...
We retrospectively reviewed the radiographic findings of fibrosing mediastinitis (FM) in 33 patients. Imaging studies included chest radiographs, computed tomographic scans, magnetic resonance imaging examinations, esophograms, ventilation perfusion scans, angiograms, and venograms. Findings include bronchial narrowing in 11 patients (33 percent), pulmonary artery obstruction/narrowing in 6 patients (18 percent), esophageal narrowing in 3 patients (9 percent), and superior vena cava obstruction/...
119 CitationsSource
#1Harold C. Urschel (University of Texas Health Science Center at San Antonio)H-Index: 34
#2Maruf A. Razzuk (University of Texas Health Science Center at San Antonio)H-Index: 18
Last. Soo Young Chung (University of Texas Health Science Center at San Antonio)H-Index: 1
view all 5 authors...
Abstract Recognition that many patients with benign sclerosing mediastinitis have smoldering disease responsible for failure of surgical procedures or for development of collateral circulation in patients with superior vena caval obstruction has markedly improved management of these difficult patients. Histoplasmosis complement fixation titers have been used to detect unsuspected subacute disease and to follow the therapeutic adjunctive management with ketoconazole, an oral antifungal agent. Twe...
54 CitationsSource
#1Edward J. Dunn (Jewish Hospital)H-Index: 1
#2Karl S. Ulicny (Jewish Hospital)H-Index: 1
Last. Leonard Gottesman (Jewish Hospital)H-Index: 3
view all 4 authors...
Sclerosing mediastinitis is an uncommon disease associated with a multiplicity of clinical syndromes. The cause of this disorder is probably an abnormal fibroproliferative response to an inflammatory stimulus, most commonly a granulomatous infection secondary to Histoplasma capsulatum . The pathophysiology of this disease is predicated on the encasement of mediastinal vital organ structures within a dense fibrotic mass. This mass appears to emanate from an invasive chronic inflammatory process c...
47 CitationsSource
Cited By1
#1Tamar Giorgadze (Cornell University)H-Index: 14
#2June Koizumi (Cornell University)H-Index: 13
Last. Cynthia M. Magro (Cornell University)H-Index: 58
view all 5 authors...
Abstract Sclerosing mediastinitis (SM) is an aggressive fibroproliferative process in the mediastinum that may lead to encasement of mediastinal structures within a dense fibrotic mass. This disease may cause significant clinical complications, morbidity, and even mortality. The etiology and pathogenesis of SM is unclear and in more than one third of cases remains idiopathic. Among the known causes of SM, granulomatous infection is the commonest. Association of SM with radiation therapy has been...
1 CitationsSource