SESSION TITLE: Bronchology/Interventional Procedures Cases I
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PM
INTRODUCTION: Fibrosing mediastinitis is an uncommon benign disorder characterised by proliferation of dense fibrous tissue within the mediastinum. We desrcibe a patient with fibrosing mediastinitis presenting with chronic hemoptysis treated with endobronchial spray cryotherapy (SCT)
CASE PRESENTATION: A 31 year old african american female with a history of fibrosing mediastinitis presented to an outside hospital with hemoptysis 1-1.5 tablespoons 4-5 times daily. She was admitted and had bronchoscopy done without any evidence of fresh blood. She had multiple hospitalizations for the same in the last few months. Pt was then referred to us for management of fibrosing mediastinitis and hemoptysis. Initial bronchoscopy revealed inflamed and hyperemic airways mainly at the level of carina and in the bronchus intermedius. Pt had 3 cryospray treatments in 3 months interval. Repeat bronchoscopy showed almost complete resolution of hyperemia and patient reported significant improvement in hemoptysis. Three months following treatment patient remained out of the hospital with very rare episodes of hemoptysis.
DISCUSSION: Fibrosing mediastinitis is a rare complication of histoplasmosis in United States. It can result in compromise of airways, great vessels, and other mediastinal structures. Mechanisms are invasion of mucosa by fibrous tissue, post-obstructive necrotizing pneumonia, pulmonary venous hypertension due to pulmonary venous obstruction and pulmonary artery obstruction causing extensive functional anastomoses between the intercostal/bronchial arteries and the pulmonary arteries. Few treatments have been reported to manage FM related hemoptysis including Nd: YAG laser, radiation therapy and SCT. We report the second case of FM related hemoptysis successfully treated with SCT
CONCLUSIONS: SCT may represent a potential therapy for FM related hemoptysis. Spray cryotherapy is a non-contact mode of treatment using a low pressure delivery system allowing the treatment of wide areas.. Studies have shown no damage to the connective tissue or extracellular matrix.
Reference #1: Weinberger SE. Fibrosing mediastinitis. In: Uptodate, Post TW (Ed), Uptodate, Waltham, MA
Reference #2: Crossno PF, et al. Massive hemoptysis: an unusual cause and an unusual treatment, Chest. 2007: 132: 667a
Reference #3: Downie G, Lewis M, Wellikoff A. Dramatic reduction of CEA post spray cryotherapy in a patient with pleural based malignancy. J Pulmon Resp Med 2013; S14:005
DISCLOSURE: Gordon Downie: Shareholder: Owns stocks The following authors have nothing to disclose: Madhuri Kamatham, Adam Wellikoff, Robert Holladay
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