Granulomatous Mediastinitis and Fibrosing Mediastinitis
Etiology
Granulomatous Mediastinitis
- Blastomycosis (see Blastomycosis, [[Blastomycosis]])
- Histoplasmosis (see Histoplasmosis, [[Histoplasmosis]]): most common cause in the US
- Sarcoidosis (see Sarcoidosis, [[Sarcoidosis]])
- Tuberculosis (see Tuberculosis, [[Tuberculosis]]): common cause in the US
Fibrosing Mediastinitis
- Blastomycosis (see Blastomycosis, [[Blastomycosis]])
- Familial Multifocal Fibrosclerosis
- Histoplasmosis (see Histoplasmosis, [[Histoplasmosis]])
- Hodgkin’s Disease (Nodular Sclerosing) (see Hodgkin’s Disease, [[Hodgkins Disease]])
- Methysergide (see Methysergide, [[Methysergide]])
- Paraffin: previously used for plombage to treat tuberculosis
- Radiation Therapy
- Sarcoidosis (see Sarcoidosis, [[Sarcoidosis]])
- Silicosis (see Silicosis, [[Silicosis]])
- Traumatic Mediastinal Hematoma
- Tuberculosis (see Tuberculosis, [[Tuberculosis]])
Clinical Presentations
- Mediastinal Mass (see Mediastinal Mass, [[Mediastinal Mass]])
- Diagnosis
- CXR/Chest CT: mediastinal mass
- Bronchial Compression (see Obstructive Lung Disease, [[Obstructive Lung Disease]])
- Physiology
- Subcarinal/hilar node involvement: obstructs mainstem bronchi, esophagus, and pulmonary vessels
- Extrinsic bronchial compression due to mediastinal fibrosis
- Diagnosis
- CXR/Chest CT: post-obstructive atelectasis or pneumonia
- V/Q Scan: will reveal if affected lung is participating in gas exchange
- Superior Vena Cava (SVC) Syndrome (see Superior Vena Cava Syndrome, [[Superior Vena Cava Syndrome]])
- Physiology
- Right paratracheal node involvement: obstructs SVC and azygous vein
- Esophageal Compression (see Dysphagia, [[Dysphagia]])
- Physiology
- Subcarinal/hilar node involvement: obstructs mainstem bronchi, esophagus, and pulmonary vessels
- Pulmonary Venous Entrapment with Resulting Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])
- Physiology
- Subcarinal/hilar node involvement: obstructs mainstem bronchi, esophagus, and pulmonary vessels
- Pulmonary venous obstruction or invasion by mediastinal fibrosis -> pulmonary hypertension
- Diagnosis
- V/Q Scan: will reveal if affected lung is participating in gas exchange
- Clinical: findings may mimic chronic thromboembolic pulmonary hypertension
- Pulmonary Artery Entrapment with Resulting Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])
- Physiology
- Subcarinal/hilar node involvement: obstructs mainstem bronchi, esophagus, and pulmonary vessels
- Pulmonary artery obstruction or invasion by mediastinal fibrosis -> pulmonary hypertension
- Diagnosis
- V/Q Scan: will reveal if affected lung is participating in gas exchange
- Clinical: findings may mimic chronic thromboembolic pulmonary hypertension
- Broncholithiasis (see Broncholithiasis, [[Broncholithiasis]])
- Hemoptysis (see Hemoptysis, [[Hemoptysis]])
Treatment
References
- Mediastinal fibrosis. Semin Respir Infect 2001;16:119–30.
- Mediastinal fibrosis complicating histoplasmosis. Medicine (Baltimore) 1988;67: 295–310.
- Mediastinal fibrosis complicating healed primary histoplasmosis and tuberculosis. Medicine (Baltimore) 1972;51:227– 46
