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

  • xxx

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