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Lung Pathology |

An Innovative Approach to Treating Recurrent Hemoptysis Caused by Fibrosing Mediastinitis

Mark Pluym, MD; Mark Yagan, MD
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University of Missouri Kansas City, Kansas City, MO


Chest. 2015;148(4_MeetingAbstracts):619A. doi:10.1378/chest.2250348
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Abstract

SESSION TITLE: Lung Pathology Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Fibrosing mediastinitis is the result of an excessive fibrotic reaction in the mediastinum, thought to be a rare sequela of a prior infection by Histoplasmosis capsulatum. Complications result from the affected structures in the mediastinum and can include; airway compression, bronchial erosion, pulmonary artery and vein stenosis, constrictive pericarditis, superior vena cava syndrome, esophageal compression, and tracheoesophageal fistula formation. Multiple treatment modalities have been investigated, including antifungal agents, glucocorticoids, surgical resection of affected structures, as well as stenting (endovascular and endobronchial). The natural history of the disease is variable, as are the efficacy of therapy options. We present a case of persistent hemoptysis in a 24 year old male which was treated with pulmonary vein stenting.

METHODS: CT angiogram of the chest on admission showed extensive mediastinal lymphadenopathy with intrinsic calcifications and narrowing of the right pulmonary artery and right superior pulmonary vein. Ground glass opacities in the right upper and middle lobes were also noted. Bronchoscopy showed diffuse edema and venous congestion of the airways. There was a moderate amount of endobronchial bleeding with only minimal scope trauma. Transesophageal echocardiogram showed left upper and right upper pulmonary vein stenosis. Pulmonary venous congestion secondary to mediastinal fibrosis and occlusion of the pulmonary veins was suspected as the cause of the patient’s recurrent hemoptysis.

RESULTS: The patient underwent stenting of the left and right superior pulmonary veins with no residual stenosis. Over the following days, the patient did not have any further episodes of hemoptysis and he was discharged two days following the stenting procedure.

CONCLUSIONS: Fibrosing mediastinitis can present with a wide array of complications and is a rare cause of hemoptysis. Our patient presented with daily episodes of hemoptysis that were attributed to pulmonary venous congestion. Pulmonary vein stenting resulted in the cessation of hemoptysis.

CLINICAL IMPLICATIONS: Pulmonary vein stenosis should be considered in patients with fibrosing mediastinitis who present with hemoptysis. Pulmonary vein stenting represents an innovative approach in treating patients with recurrent hemoptysis caused by pulmonary venous congestion. In our case, the underlying cause was fibrosing mediastinitis, however, other causes of pulmonary vein stenosis may also be amendable to pulmonary vein stenting.

DISCLOSURE: The following authors have nothing to disclose: Mark Pluym, Mark Yagan

No Product/Research Disclosure Information


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