Abstract
Introduction
Fibrosing mediastinitis (FM) is a rare, often progressive condition that consists on a proliferation of fibrous tissue within the mediastinum. Etiology is usually unknown, but in endemic areas granulomatous infections have been implicated.
Objectives
We describe a rare case of a patient with pleural tuberculosis (TB) and FM.
Methods
Medical consultation, exams and analysis of the medical files.
Discussion
A 42 year old male with pleural TB histologically confirmed, receiving standard treatment, referred syncope episodes, with no prodromes, associated with orthopnea, dyspnea (mMRC 2) and cervical swelling. HRCT showed a mediastinal infiltrative mass obliterating the superior vena cava's lumen, some mediastinal and hilar lymphadenomegalies and right pleural effusion. Mediastinoscopic guided biopsy showed no granulomas or atypical cells, revealing many areas of fibrohyalinosis with calcificating necrosis in conjunctive and lymphoid tissues, and cultures were negative for fungi and mycobacteria. The cava compression was confirmed by angiotomography and doppler ultrasonography of cervical vessels, also diagnosing right internal jugular acute vein thrombosis.
Despite anticoagulation and the TB treatment completion, with full resolution of the other findings, there was no regression of the mediastinal mass or vascular compression.
Conclusion
Clinical, radiological and histological findings leaded to the diagnosis of superior vena cava syndrome and FM, here presented in its diffuse pattern, which happens in 18% of the cases.
FM could be a sequel of successfully treated tuberculosis. It often has an unpredictable course; periods of both spontaneous remission and exacerbation of symptoms have been reported.
- © 2014 ERS