Peking University First Hospital, Beijing, China
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Cardiothoracic
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM
PURPOSE: Fibrosing mediastinitis (FM) is a rare disease with characteristic manifestation on computed tomography (CT) scan. It was reported mostly in histoplasmosis endemic regions. We analyzed the clinical, imaging and bronchoscopic features of Chinese patients with FM, and to promote the awareness of this disease.
METHODS: Between January 2005 and June 2015, 22 patients were diagnosed in our hospital. The medical records including clinical features, imaging manifestations, bronchoscopic findings and pathological manifestations were analyzed.
RESULTS: A total of 22 patients were analyzed (10 male and 12 female). The age range was from 43 to 88 years with a mean age of 70.1 years. Half of the patients had evidence of previous or latent tuberculous infections. Clinical symptoms included dyspnea (81.8%), cough (77.3%), expectoration (31.8%) and fever (13.6%). Chest CT scans showed a diffuse homogeneous soft tissue process throughout the mediastinum and bilateral pulmonary hili. Calcification in the mediastinum was common (68.2%). Multiple bronchial stenosis of the lobe and/or segmental bronchi was frequently present. Pulmonary arterial and/or venous compression was seen in all of the cases, with widening of the trunk of the pulmonary artery in 10 cases (45.5%) and unilateral/localized interstitial pulmonary edema or pleural effusion in 7 cases (31.8%). Bronchoscopy examination revealed diffused swelling of bronchial mucosa and multiple bronchial distortion and stenosis. Multiple black pigmentation of the bronchial mucosa was shown in 12 cases (92.3%). 9 patients were treated with anti-tuberculosis drugs and 3 of them reported obvious relief of the symptoms.
CONCLUSIONS: FM in Chinese patients is most likely associated with TB infections. There are several differences between the Chinese cases and cases from histoplasmosis endemic regions. Anti-tuberculosis therapy maybe effective for some patients, but should be demonstrated by further larger scale studies.
CLINICAL IMPLICATIONS: Increasing the awareness of FM is important so that the contrast-enhanced CT examinations should be considered when the patients have poor responses to routine treatment for COPD, asthma or pneumonia. The clinical prognosis of FM of Chinese patients, the link to TB and the effectiveness of anti-TB treatment need to be illuminated by further studies.
DISCLOSURE: The following authors have nothing to disclose: Yan Hu, Guangfa Wang, Jiping Liao, Hong Zhang, Zhe Jin, Ying Liu
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