Fibrosing mediastinitis presenting as pulmonary stenosis: stenting works.

Published on Jun 12, 2007in International Journal of Cardiology3.229
· DOI :10.1016/J.IJCARD.2007.01.030
Ruby Satpathy7
Estimated H-index: 7
(Creighton University),
Virginia Aguila1
Estimated H-index: 1
(Creighton University)
+ 1 AuthorsIjaz A. Khan37
Estimated H-index: 37
(UMB: University of Maryland, Baltimore)
Abstract A rare case of fibrosing mediastinitis from histoplasmosis with extrinsic compression of the right pulmonary artery is reported. A 41-year-old patient presented with worsening symptoms of cough, fever, migratory arthralgia, chest pain, and progressive dyspnea. The pulmonary artery involvement was suspected by transthoracic echo and was confirmed by transesophageal echo, CT scan of chest, and right heart catheterization. Diagnosis of histoplasmosis was confirmed by biopsy and serological tests. Patient has been free from symptoms of pulmonary stenosis for 4 years after successful pulmonary artery stenting.
📖 Papers frequently viewed together
53 Citations
97 Citations
4 Authors (James E. Loyd, ..., Des Prez Rm)
145 Citations
#1Christina Routsi (UoA: National and Kapodistrian University of Athens)H-Index: 28
#2Christos CharitosH-Index: 17
Last. Epaminondas Zakynthinos (UTH: University of Thessaly)H-Index: 12
view all 5 authors...
Abstract An unusual case of fibrosing mediastinitis with obstruction of the inferior and superior left pulmonary veins and severe narrowing of the right pulmonary artery, disclosed after unilateral pulmonary edema, is described. The 18-year-old male patient had a long history of cough, progressive dyspnea and recurrent hemoptysis and the possible diagnosis of "interstitial fibrosis" from a previous lung biopsy. The diagnosis and the pulmonary vessels involvement were suspected after right heart ...
13 CitationsSource
#1Arthur B. Fontaine (University of Washington Medical Center)H-Index: 6
#2John J. Borsa (University of Washington Medical Center)H-Index: 14
Last. Coralli R. So (University of Washington Medical Center)H-Index: 3
view all 5 authors...
This article describes an initial experience with stent placement in three patients with severe pulmonary artery stenosis secondary to fibrosing mediastinitis. All three patients were severely symptomatic on admission and all three were asymptomatic after treatment and remained symptom-free approximately 1 year after treatment.
17 CitationsSource
#1Thomas P. Doyle (Vandy: Vanderbilt University)H-Index: 9
#2James E. LoydH-Index: 69
Last. Ivan M. RobbinsH-Index: 42
view all 3 authors...
Mediastinal fibrosis is a rare consequence of infection with the fungus Histoplasma capsulatum that can lead to occlusion of large pulmonary arteries and veins and mainstem bronchi. Medical and surgical treatments for this disorder have been ineffective. We describe successful treatment for central pulmonary arterial and venous obstruction due to mediastinal fibrosis in four patients using percutaneously placed intravascular stents. Patients were severely limited, World Health Organization funct...
97 CitationsSource
#1David E. Kandzari (Duke University)H-Index: 48
#2John J. Warner (Duke University)H-Index: 15
Last. J. Kevin Harrison (Duke University)H-Index: 33
view all 4 authors...
Pulmonary artery stenosis is an uncommon complication of fibrosing mediastinitis. Previous medical and surgical therapies have provided limited clinical efficacy without objective evidence of clinical improvement. With the advantages of limited invasiveness and absent need for prolonged drug therapy, percutaneous stent deployment to relieve pulmonary artery obstruction represents a novel treatment for this rare disorder. Cathet. Cardiovasc. Intervent. 49:321–324, 2000. © 2000 Wiley-Liss, Inc.
53 CitationsSource
#1James E. Loyd (Vandy: Vanderbilt University)H-Index: 69
Last. Des Prez RmH-Index: 3
view all 4 authors...
: Mediastinal fibrosis, the most serious late complication of remote infection by Histoplasma capsulatum, is a thick, dense fibrotic capsule which surrounds a small mediastinal focus of old caseous adenitis. The fibrotic process may accrue over prolonged periods and extend within the lumina of critical mediastinal structures to produce complete occlusion. We summarized clinical and radiographic data for 71 patients with mediastinal fibrosis; the criteria for inclusion were the clinical demonstra...
145 CitationsSource
#1Goodwin RaH-Index: 4
#2Nickell JaH-Index: 1
Last. Des Prez RmH-Index: 3
view all 3 authors...
163 CitationsSource
Cited By13
#1John P. Welby (Mayo Clinic)H-Index: 4
#2Erin A. Fender (Mayo Clinic)H-Index: 9
Last. Erica M. Knavel-Koepsel (Mayo Clinic)
view all 6 authors...
: 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...
1 CitationsSource
#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
#1M. M. SleeperH-Index: 1
#2A. Barton-LambH-Index: 1
Last. P. S. DoyleH-Index: 1
view all 3 authors...
Summary In the case presented, a young horse was referred for further evaluation based on a presumptive diagnosis of pulmonic valve endocarditis, bronchopneumonia and a cranial mediastinal abscess based on thoracic ultrasound, echocardiography and clinical signs. However, further echocardiographic evaluation revealed that the abscess was compressing the right ventricular outflow track causing outflow obstruction, a murmur associated with right ventricular outflow tract obstruction (acquired pulm...
1 CitationsSource
Hintergrund Die chronische Mediastinitis ist eine seltene Erkrankung, welche durch fortschreitende Proliferation fibrosen Gewebes im Mediastinum eine Kompression mediastinaler Strukturen verursacht.
Idiopathic mediastinal fibrosis is a rare, histologically benign condition which often presents with symptoms attributable to compression of vital mediastinal structures. Diagnosis can be difficult and individualized treatments are required for patients, with possible intervention including pharmacotherapy, surgery, and percutaneous stenting. We present a case of idiopathic mediastinal fibrosis present in a 50-year-old woman as compression and near obliteration of the pulmonary arteries. A percu...
3 CitationsSource
#1M. Serraj (SIDI)H-Index: 1
#1Mounia Serraj (SIDI)H-Index: 1
Last. M.C. Benjelloun (SIDI)H-Index: 6
view all 7 authors...
Resume La mediastinite sclerosante est une affection rare et benigne ; c’est la compression des structures mediastinales par la fibrose, qui conditionne sa presentation clinique et son pronostic. L’obstruction des structures veineuses pulmonaires par la fibrose mediastinale a ete rarement rapportee, cliniquement elle mime le retrecissement mitral. Nous decrivons le cas clinique d’une jeune patiente suivie pour mediastinite sclerosante idiopathique dont le bilan retrouve une stenose de l’artere p...
Idiopathic mediastinal fibrosis (IMF) is an uncommon clinical condition and the manifestations of this disease vary from a relatively benign disorder with minor symptoms to severe pulmonary vascular occlusion leading to mortality, commonly presenting a diagnostic and therapeutic challenge. Here, we present the case of a Taiwanese woman with obstruction of the left pulmonary veins and artery and stenosis of the left main coronary artery (LMCA) resulting from IMF. To our knowledge, this is the fir...
1 CitationsSource
#1Steven R. Bruhl (University of Toledo Medical Center)H-Index: 4
#2Mujeeb Sheikh (University of Toledo Medical Center)H-Index: 7
Last. Utpal Pandya (University of Toledo Medical Center)H-Index: 4
view all 5 authors...
Abstract Although pulmonary artery stenosis and its treatment has been well characterized in pediatric populations, its diagnosis and even how to determine the significance of a stenosis can be difficult and optimal management is currently unknown. This case report and review of the literature outlines how we successfully diagnosed, evaluated, and stented a patient with radiation induced pulmonary artery stenosis. This case further adds support to a very limited data pool suggesting that percuta...
5 CitationsSource
#1Tobias Peikert (Mayo Clinic)H-Index: 29
#2Thomas V. ColbyH-Index: 105
Last. Ulrich SpecksH-Index: 63
view all 7 authors...
Fibrosing mediastinitis (FM) is a rare disorder characterized by the invasive proliferation of fibrous tissue within the mediastinum. FM frequently results in the compression of vital mediastinal structures and has been associated with substantial morbidity and mortality. Its pathogenesis remains unknown. However, in North America most cases are thought to represent an immune-mediated hypersensitivity response to Histoplasma capsulatum infection. To characterize the clinical disease spectrum, na...
67 CitationsSource