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Mitrovic-Jovanovic M, Skrobic O, Odalovic S, Djikic Rom A, Plavsic A, Jankovic A, Kostadinovic M, Ivanovic N, Simic A, Djuric-Stefanovic A, Kovac JD. CT and 18FDG-PET/CT findings in progressive mediastinal idiopathic fibrosis as a benign mimicker of esophageal carcinoma: a case report. J Int Med Res 2023; 51:3000605231213212. [PMID: 38041832 PMCID: PMC10693803 DOI: 10.1177/03000605231213212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/23/2023] [Indexed: 12/04/2023] Open
Abstract
Idiopathic mediastinal fibrosis, also called sclerosing or fibrosing mediastinitis, is a very rare and aggressive fibroinflammatory process characterized by fibrous tissue proliferation in the mediastinal region. Herein, we present a rare case of idiopathic mediastinal fibrosis presenting with esophageal obstruction, most likely associated with immunoglobulin G (IgG4)-related disease, affecting the posterior mediastinum with intrapulmonary infiltration. Computed tomography revealed a narrowed lumen and thickened wall of the distal esophagus surrounded by a necrotic mass with infiltration into the nearby structures, suggesting a locally advanced malignant process. Positron emission tomography revealed intense accumulation of 18F-fluorodeoxyglucose, indicating an active inflammatory component, which complicates further differential diagnosis of mediastinal masses. Thoracoscopic biopsy and immunohistochemical analysis confirmed a fibroinflammatory process with perivascular lymphoid cell infiltration that was cluster of differentiation (CD)3 (++) and CD20 (++), with massive numbers of IgG4-immunoreactive plasma cells. Although a benign condition, sclerosing mediastinitis is a close mimicker of esophageal carcinoma, which cannot be differentiated by computed tomography or positron emission tomography and must be considered in a differential diagnosis.
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Affiliation(s)
- Milica Mitrovic-Jovanovic
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Ognjan Skrobic
- Department of Esophageal and Gastric Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Koste Todorovica Street, Belgrade, Serbia
- Department of Surgery and Anesthesiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Strahinja Odalovic
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
- Center for Nuclear Medicine, University Clinical Centre of Serbia, No. 26 Višegradska street, Belgrade, Serbia
| | - Aleksandra Djikic Rom
- Department of Pathology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
| | - Aleksandra Plavsic
- Clinic of Allergy and Immunology, University Clinical Centre of Serbia, No. 2 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Internal medicine, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica street, Belgrade, Serbia
| | - Aleksandra Jankovic
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Milena Kostadinovic
- Center for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, No. 2 Pasterova Street, Belgrade, Serbia
| | - Nenad Ivanovic
- Department of Esophageal and Gastric Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Koste Todorovica Street, Belgrade, Serbia
- Department of Surgery and Anesthesiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Aleksandar Simic
- Department of Esophageal and Gastric Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Koste Todorovica Street, Belgrade, Serbia
- Department of Surgery and Anesthesiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Aleksandra Djuric-Stefanovic
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Jelena Djokic Kovac
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
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Sadiq AM, Raza FM, Abdulrahimu YR, Mwacha CP, Sadiq AM, Lyamuya FS. Idiopathic fibrosing mediastinitis with esophageal varices: A case report. Heliyon 2023; 9:e15780. [PMID: 37144209 PMCID: PMC10151416 DOI: 10.1016/j.heliyon.2023.e15780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
Fibrosing mediastinitis (FM) is a rare cause of lung fibrosis with multiple etiologies ranging from infectious to autoimmune to idiopathic. Common causes of FM include histoplasmosis and a relatively new cause of IgG4-related disease. We present a 55-year-old male with symptoms of esophageal varices, intractable hiccups, and progressive difficulty in breathing. A chest X-ray showed right lung fibrosis with pleural effusion and loss of lung volume, which was originally thought to be the sequelae of SARS-CoV-2 or metastasis, but computed tomography of the chest revealed FM. His variceal bleeding was controlled, and he was discharged home. However, treatment for FM was not pursued because the cause was not identified. Using corticosteroids may not cease the progression of the disease, and surgical options are available when symptoms persist. Idiopathic FM requires laboratory and radiological findings to exclude relevant differential diagnoses.
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Affiliation(s)
- Abid M. Sadiq
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Corresponding author. Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
| | - Faryal M. Raza
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Yazid R. Abdulrahimu
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Christian P. Mwacha
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Adnan M. Sadiq
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Radiology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Furaha S. Lyamuya
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Choudhary SS, Khedkar CR, Aurangabadkar GM, Khan SM. Chronic Tubercular Mediastinitis: A Rare Case Presentation With Subcutaneous Emphysema. Cureus 2023; 15:e38832. [PMID: 37303353 PMCID: PMC10253243 DOI: 10.7759/cureus.38832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Tuberculosis, histoplasmosis, various fungal infections, malignancy, and sarcoidosis are the most common causes of chronic or slowly progressing mediastinitis. Chronic mediastinitis of tubercular origin with subcutaneous emphysema is exceptionally uncommon, and the majority of cases are caused by trauma. Here we report the case of a 35-year-old chronic alcoholic male who presented to the Outpatient Department (OPD) with complaints of cough, chest pain, loss of weight, and intermittent low-grade fever for three months with no significant past medical history or family history for any respiratory diseases. He was admitted and all routine investigations were performed, which were normal including his chest X-ray, except erythrocyte sedimentation rate (ESR) which was raised. The patient's high-resolution Computed Tomography (HRCT) of the thorax was done which showed multiple pleural-based nodular lesions with few showing central cavitary nodules along with ground glass appearance. It also showed two fistulous tracks of 3.4-millimeter diameter, arising from the trachea at the T1 - T2 vertebral level and at the carina which led to the presence of air in the subcutaneous plane extending from the neck up to visualized abdomen suggestive of chronic mediastinitis with tracheal fistula, along with subcutaneous emphysema. This fistula was confirmed by video bronchoscopy as well as three-dimensional (3D) virtual bronchoscopy. A biopsy was taken, which was positive for acid-fast bacilli (AFB) stain, polymerase chain reaction (PCR) for tuberculosis, and positive tuberculin skin test. The patient was started on anti-tubercular treatment and on a follow-up visit upon completion of the intensive phase, his HRCT and video bronchoscopy showed fibrosing scarring with fistula closure.
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Affiliation(s)
- Sumer S Choudhary
- Respiratory Medicine, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Nagpur, IND
| | - Chetan R Khedkar
- Department of Medicine, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, IND
| | - Gaurang M Aurangabadkar
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Shafee M Khan
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Abstract
Fibrosing mediastinitis is rare in settings where histoplasmosis is not endemic. An idiopathic form of the disease may present with
indistinguishable features and requires methodical exclusion of competing differential diagnoses. We report the case of a 30-year old female
patient who presented with intermittent haemoptysis for the past 2 years with no constitutional symptoms. Computed tomography of the
chest revealed a prominent right bronchial arterial circulation with a mass-like lesion, which encased and attenuated the right pulmonary
trunk and adjacent structures. Endobronchial ultrasonography with transbronchial fine-needle aspiration showed a paucicellular aspirate
with no evidence of malignancy or granulomas. Fungal infection, tuberculosis, sarcoidosis, IgG4-disease, and connective tissue disease were
ruled out by appropriate serological, molecular, and microbiological tests. A diagnosis of idiopathic fibrosing mediastinitis was therefore
made by exclusion and the patient was successfully treated with oral corticosteroids.
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Lin J, Jimenez CA. Acute mediastinitis, mediastinal granuloma, and chronic fibrosing mediastinitis: A review. Semin Diagn Pathol 2021; 39:113-119. [PMID: 34176697 DOI: 10.1053/j.semdp.2021.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 11/11/2022]
Abstract
Acute mediastinitis is a rare infection that carries high morbidity and mortality. They are complications seen most often with deep sternal wound infections from surgeries with median sternotomies, oropharyngeal and odontogenic infections and esophageal perforations. These conditions should be promptly recognized and treated. Mediastinal granulomas are focal, mass-like lesions commonly resulting from prior granulomatous infections. They are regarded as benign, self-resolving lesions however can cause complications by compression of adjacent mediastinal structures. Chronic fibrosing mediastinitis is a rare, diffuse fibroinflammatory process most often seen with granulomatous infections and carries a worse prognosis than mediastinal granulomas especially when adjacent mediastinal structures are compromised. In this review, we discuss the epidemiology, etiology, clinical presentation, treatment and prognosis of acute mediastinitis, mediastinal granulomas, and chronic fibrosing mediastinitis.
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Affiliation(s)
- Julie Lin
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Vaideeswar P, Chaudhari J, Goel N. Fungal fibrosing mediastinitis in pregnancy - Case report with review of literature. J Postgrad Med 2020; 65:52-55. [PMID: 30693874 PMCID: PMC6380127 DOI: 10.4103/jpgm.jpgm_358_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fibrosing mediastinitis (FM) is characterized by extensive and invasive fibro-inflammatory proliferation, triggered by a delayed hypersensitivity reaction to variety of infective or noninfective stimuli. The infective agents often have a geographic distribution such as Histoplasma capsulatum in North America and Mycobacterium tuberculosis in Asian regions. In few reports, the mediastinitis is caused by fungi, particularly Aspergillus species. We report the first case of possible aspergillous FM in a young pregnant woman.
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Affiliation(s)
- P Vaideeswar
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - J Chaudhari
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Goel
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Carbone RG, Murdaca G, Negrini S, Penna D, Puppo F. Diagnosis of an unusual case of idiopathic mediastinal fibrosis by 18F-FDG PET/CT. Radiol Case Rep 2020; 15:435-436. [PMID: 32099588 PMCID: PMC7029048 DOI: 10.1016/j.radcr.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 11/01/2022] Open
Abstract
Diagnosis of idiopathic mediastinal fibrosis was done by exclusion in a 54-year-old woman with dyspnoea, chest pain, cough and fatigue showing positivity of 2-deoxy-2-[18F]fluoro-D-glucose positron-emission tomography/computed tomography total body imaging which turned out to normal after six and eighteen months of prednisone and pirfernidone treatment.
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Garrana SH, Buckley JR, Rosado-de-Christenson ML, Martínez-Jiménez S, Muñoz P, Borsa JJ. Multimodality Imaging of Focal and Diffuse Fibrosing Mediastinitis. Radiographics 2019; 39:651-667. [PMID: 30951437 DOI: 10.1148/rg.2019180143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fibrosing mediastinitis is a rare benign but potentially life-threatening process that occurs because of proliferation of fibrotic tissue in the mediastinum. The focal subtype is more common and typically is associated with an abnormal immunologic response to Histoplasma capsulatum infection. Affected patients are typically young at presentation, but a wide age range has been reported, without a predilection for either sex. The diffuse form may be idiopathic or associated with autoimmunity, usually affects middle-aged and/or elderly patients, and is more common in men. For both subtypes, patients present with signs and symptoms related to obstruction or compression of vital mediastinal structures. The most common presenting signs and symptoms are cough, dyspnea, recurrent pneumonia, hemoptysis, and pleuritic chest pain. Patients with the diffuse subtype may have additional extrathoracic symptoms depending on the other organ systems involved. Because symptom severity is variable, treatment should be individualized with therapies tailored to alleviate compression of the affected mediastinal structures. Characteristic imaging features of fibrosing mediastinitis include infiltrative mediastinal soft tissue (with or without calcification) with compression or obstruction of mediastinal vascular structures and/or the aerodigestive tract. When identified in the appropriate clinical setting, these characteristic features allow the radiologist to suggest the diagnosis of fibrosing mediastinitis. Careful assessment is crucial at initial and follow-up imaging for exclusion of underlying malignancy, assessment of disease progression, identification of complications, and evaluation of treatment response. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Sherief H Garrana
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Jennifer R Buckley
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Melissa L Rosado-de-Christenson
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Santiago Martínez-Jiménez
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Phillip Muñoz
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - John J Borsa
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
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9
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Liu T, Gao L, Xie S, Sun H, Liu M, Zhai Z. Clinical and imaging spectrum of tuberculosis-associated fibrosing mediastinitis. CLINICAL RESPIRATORY JOURNAL 2018; 12:1974-1980. [PMID: 29356415 DOI: 10.1111/crj.12766] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/03/2017] [Accepted: 01/09/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Fibrosing mediastinitis (FM) is a rare disorder characterized by an excessive fibrotic reaction within the mediastinum, which can result in compression of mediastinal structures. To investigate the clinical and imaging characteristics of TB-associated FM, patients with evidence of TB infection were retrospectively evaluated in this study. MATERIALS AND METHODS A total of 33 patients with clinically diagnosed FM and evidence of TB infection were selected from the database of two institutional medical centers. Medical records were reviewed to evaluate the clinical disease spectrum, responses to therapy and imaging characteristics. RESULTS TB-associated FM showed distinctive infiltrative pattern on chest CT, such as bilateral involvement and hilar predominance. The majority of patients presented with nonspecific respiratory symptoms due to the compression of mediastinal broncho-vascular structures. Echocardiography discovered pulmonary hypertension to various degrees in 60% of patients. Although only a part of patients responded to medical therapy, they seldom showed deterioration during the follow-up. CONCLUSIONS TB-associated FM shows some specific imaging characteristics, reflecting immune-mediated fibrotic reaction secondary to TB infection. The insidious progression to mediastinal fibrosis after TB infection poses a challenge to the early diagnosis and results in subsequent respiratory dysfunction and pulmonary hypertension.
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Affiliation(s)
- Tongxi Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Li Gao
- Department of Radiology, Peking University First Hospital, Beijing, 100034, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhenguo Zhai
- Department of Respiratory and Critical Care medicine, China-Japan Friendship Hospital, Beijing, 100029, China
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Abstract
BACKGROUND A systematic approach to the etiology and possible course of acute mediastinitis is a prerequisite for adequate diagnostics and therapy. Chronic mediastinitis represents a rarity in the clinical practice. MATERIAL AND METHOD A selective literature search was carried out. RESULTS An acute infection of the mediastinum occurs after perforation of mediastinal structures, such as the esophagus and trachea mostly of iatrogenic origin and as descending necrotizing mediastinitis (DNM) from oropharyngeal foci. The mortality rate of esophageal injuries, irrespective of the cause is currently given as 12 %. A DNM results from an unobstructed spread along the cervicothoracic spaces and is a severe infection which manifests as a clinical picture of sepsis. The mortality rate given in the currently available literature is 14 %. Chronic mediastinitis is a very rare condition which is characterized by the proliferation of fibrous and collagenous tissue in the mediastinum. Whereas the pathogenesis remains unclear, there are indications for a Histoplasma capsulatum infection as the causal link. The prognosis is good. CONCLUSION After perforation of the esophagus or trachea there is always the risk of an infection of the mediastinum; therefore, the diagnosis is followed by further evaluation and early therapy. The DNM can cause unspecific symptoms of sepsis without an obvious focal point. It is important to be aware of a possible correlation between an oropharyngeal center of infection and mediastinitis in order to initiate appropriate diagnostic imaging in cases with the slightest suspicion. Chronic mediastinitis is a rare condition with varying courses and can be difficult to diagnose. An histological clarification for distinction from malignant diseases appears to be a sensible approach.
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Affiliation(s)
- J Kluge
- Klinik für Thoraxchirurgie und thorakale Endoskopie, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Deutschland.
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Patterson J, Graham D, George A, Will M, Sutter D. Right Middle Lobe Collapse and Pleural Effusion in an 18-Year-Old Man. Chest 2017; 152:e33-e38. [PMID: 28797398 DOI: 10.1016/j.chest.2017.04.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022] Open
Abstract
An 18-year-old African American male subject presented to an acute care clinic with 3 days of productive cough, chills, pleuritic right chest pain, sore throat with hoarseness, congestion, and intermittent shortness of breath. He recently relocated to Texas from Georgia to undergo basic military training. He denied any other recent travel or contact with persons with pulmonary TB or other respiratory illnesses. His medical history was significant for glucose-6-phosphate dehydrogenase deficiency and sickle cell trait.
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Affiliation(s)
- Joshua Patterson
- Department of Pediatrics, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - David Graham
- Department of Cardiothoracic Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - Alan George
- Department of Pathology, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - Micah Will
- Department of Pathology, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - Deena Sutter
- Department of Pediatrics, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX.
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Xu Y, Xu W, Liu Y, Tian X, Xu K, Shi J, Wang M, Cai B, Peng M. Pulmonary hypertension associated with combined fibrosing mediastinitis and bronchial anthracofibrosis: A retrospective analysis in a single Chinese hospital. CLINICAL RESPIRATORY JOURNAL 2017; 12:1134-1140. [PMID: 28419740 DOI: 10.1111/crj.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 01/19/2017] [Accepted: 03/24/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Both fibrosing mediastinitis (FM) and bronchial anthracofibrosis (BAF) are unique diseases. The combined appearance of FM and BAF is extremely rare. OBJECTIVES The aim of this study was to investigate the clinical features of patients with coexisting FM and BAF. METHOD Between January 2003 and December 2015, a total of eight patients were diagnosed at the Peking Union Medical College Hospital as having combined FM and BAF. The clinical presentations, radiographic features and bronchoscopic findings of the eight patients were reviewed. RESULTS The patients were five women and three men with a median age of 64 years (range 56-86 years). Symptoms included dyspnea (eight patients), cough (seven patients), chest pain (two patients), hemoptysis (two patients) and so on. Chest CT of all eight patients showed mediastinal soft-tissue lesions, with multiple narrowed or obliterated lobar or segmental bronchi and arteries. Bronchoscopy showed that all of the patients had multiple stenoses of lobar or segmental bronchi with anthracotic pigmentation on the mucosa. Echocardiography showed that all of the patients had elevated pulmonary arterial systolic pressure (median 81 mm Hg, range 51-107 mm Hg). Each of the eight patients had a history of exposure to, or infection with, tuberculosis, although there was no evidence of active disease. All of the eight patients had long-term exposure to indoor coal or biomass fuel smoke. CONCLUSIONS FM can coexist with BAF, characterized by prominent pulmonary hypertension. The possible etiological factors are tuberculosis and coal or biomass fuel exposure.
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Affiliation(s)
- Yan Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenbing Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjian Liu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinlun Tian
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaifeng Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juhong Shi
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengzhao Wang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Baiqiang Cai
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Peng
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Abstract
Fibrosing mediastinitis, also known as sclerosing mediastinitis and mediastinal fibrosis, is an uncommon disease characterized by the proliferation of a dense fibrous tissue in the mediastinum. This article describes a patient who presented to the ED with atypical signs and symptoms that initially seemed like heart failure but were eventually diagnosed as fibrosing mediastinitis.
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Rossi GM, Emmi G, Corradi D, Urban ML, Maritati F, Landini F, Galli P, Palmisano A, Vaglio A. Idiopathic Mediastinal Fibrosis: a Systemic Immune-Mediated Disorder. A Case Series and a Review of the Literature. Clin Rev Allergy Immunol 2016; 52:446-459. [DOI: 10.1007/s12016-016-8584-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Imaging Evaluation of Mediastinal Masses in Children and Adults: Practical Diagnostic Approach Based on A New Classification System. J Thorac Imaging 2016; 30:247-67. [PMID: 26086589 DOI: 10.1097/rti.0000000000000161] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A compartmental approach to the diagnosis of the mediastinal masses in children and adults has been widely used to facilitate the diagnosis and planning of diagnostic interventions and surgical treatment for many years. Recently, a new computed tomography-based mediastinal division scheme, approved by the International Thymic Malignancy Interest Group, has received considerable attention as a potential new standard. In this review article, this new computed tomography-based mediastinal division scheme is described and illustrated. In addition, currently used imaging modalities and techniques, practical imaging algorithm of evaluating mediastinal masses, and characteristic imaging findings of various mediastinal masses that occur in children and adults are discussed. Such up-to-date knowledge has the potential to facilitate better understanding of mediastinal masses in both pediatric and adult populations.
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Bourlier D, O'Connell C, Montani D, Savale L, Seferian A, Parent F, Humbert M, Simonneau G, Sitbon O, Jaïs X. A rare case of sarcoidosis-associated pulmonary hypertension in a patient exposed to silica. Eur Respir Rev 2016; 25:93-6. [PMID: 26929426 DOI: 10.1183/16000617.0073-2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Delphine Bourlier
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Caroline O'Connell
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - David Montani
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Laurent Savale
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Andrei Seferian
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Florence Parent
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Marc Humbert
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Gérald Simonneau
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Olivier Sitbon
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Xavier Jaïs
- Univ Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM UMR_S 999, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
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Patel M, Lu F, Hannaway M, Hochman K. Fibrosing mediastinitis: a rare complication of histoplasmosis. BMJ Case Rep 2015; 2015:bcr-2015-212774. [PMID: 26538131 DOI: 10.1136/bcr-2015-212774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 29-year-old man who presented with intermittent haemoptysis for about 18 months. Previously, his symptoms had been diagnosed as musculoskeletal pain and later as pneumonia. CT found a venous infarct in the right lung in addition to extensive lymphadenopathy in the mediastinum and pulmonary hila, with associated calcifications almost completely occluding the superior vena cava and azygos vein. Further questioning revealed that the patient had once worked on an organic farm in Colorado. Subsequent work up was positive for histoplasmosis yeast antibodies. The patient was diagnosed with fibrosing mediastinitis (FM) and started on itraconazole for 3 months. We note that FM is a rare complication of histoplasmosis and can present as chronic haemoptysis. Travel history is an important aspect of the clinical evaluation. Antifungal agents have shown some efficacy in treating histoplasmosis-related FM.
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Affiliation(s)
- Milesh Patel
- New York University School of Medicine, New York, New York, USA
| | - Frederic Lu
- New York University School of Medicine, New York, New York, USA
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Bansal A, Drewek R. Sarcoidosis and Histoplasmosis: Is One a Consequence of the Other? A Case Report and Review of the Literature. Case Rep Rheumatol 2015; 2015:108459. [PMID: 26345350 PMCID: PMC4544730 DOI: 10.1155/2015/108459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 11/18/2022] Open
Abstract
Sarcoidosis involves abnormal collections of inflammatory cells (granulomas) which may form as nodules in multiple organs. 90% of affected patients have respiratory tract abnormalities. We present a 61-year-old male with sarcoidosis who was admitted for respiratory distress. Fibrosing mediastinitis was seen in the chest computograph. Management was conservative and included steroids, antibiotics, and oxygen therapy. Sarcoidosis and fibrosing mediastinitis are rare. Fibrosing mediastinitis is more commonly seen with histoplasmosis. We explore the clinical similarities between histoplasmosis and sarcoidosis. We also explore the potential cause and effect relationship and workup for each disease entity.
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Affiliation(s)
- Anupam Bansal
- Atlantic University School of Medicine, Gros Islet Highway, Rodney Bay, Saint Lucia
| | - Rupali Drewek
- Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016, USA
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Piciucchi S, Barone D, Sanna S, Dubini A, Goodman LR, Oboldi D, Bertocco M, Ciccotosto C, Gavelli G, Carloni A, Poletti V. The azygos vein pathway: an overview from anatomical variations to pathological changes. Insights Imaging 2014; 5:619-28. [PMID: 25171956 PMCID: PMC4195836 DOI: 10.1007/s13244-014-0351-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 11/24/2022] Open
Abstract
The azygos venous system represents an accessory venous pathway supplying an important collateral circulation between the superior and inferior vena cava. The aim of this article is to revise the wide spectrum of changes ranging from normal to pathological conditions involving the azygos system. Teaching points • The azygos vein is a collateral venous pathway, becoming a vital shunt if major pathways of venous return are obstructed. • In azygos continuation, the azygos vein becomes significantly enlarged due to inferior vena cava interruption. • Fibrosing mediastinitis is an underestimated acquired disorder. • Fibrosing mediastinitis induces a variable engorgement of collateral veins. • Fibrosing mediastinitis leads to superior vena cava syndrome.
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Affiliation(s)
- Sara Piciucchi
- Radiology Department, Morgagni Pierantoni Hospital, Forlì, Italy,
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Novella Sánchez L, Sanz Herrero F, Berraondo Fraile J, Fernández Fabrellas E. Mediastinal fibrosis and superior vena cava syndrome. Arch Bronconeumol 2013; 49:340-2. [PMID: 23410744 DOI: 10.1016/j.arbres.2012.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/11/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
Superior vena cava syndrome is a clear sign for clinicians of infiltrative mediastinal involvement, usually caused by neoplasms in this location, and it is an indicator of poor prognosis. However, other diseases of benign origin can also cause these alterations. We present the case of a 34-year-old patient who debuted with symptoms of superior vena cava syndrome due to idiopathic mediastinal fibrosis, which presented a torpid evolution and few therapeutic alternatives.
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McNeeley MF, Chung JH, Bhalla S, Godwin JD. Imaging of Granulomatous Fibrosing Mediastinitis. AJR Am J Roentgenol 2012; 199:319-327. [DOI: 10.2214/ajr.11.7319] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Michael F. McNeeley
- Department of Radiology, University of Washington Medical Center, 1959 Pacific Ave NE, Box 357115, Seattle, WA 98195
| | | | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology at Washington University, St. Louis, MO
| | - J. David Godwin
- Department of Radiology, University of Washington Medical Center, 1959 Pacific Ave NE, Box 357115, Seattle, WA 98195
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Krishnan AS, Babar JL, Gopalan D. Imaging of congenital and acquired disorders of the pulmonary artery. Curr Probl Diagn Radiol 2012; 41:165-78. [PMID: 22818837 DOI: 10.1067/j.cpradiol.2011.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The pulmonary artery is affected by a multitude of conditions that can be congenital or acquired. These disorders may be detected incidentally, or the clinical features of the different conditions may overlap. This pictorial review illustrates the imaging findings of some of the main conditions that affect the pulmonary artery by considering them in 3 main categories: congenital disorders; enlargement of the pulmonary arteries, most commonly seen in pulmonary hypertension; obstruction or occlusion of the pulmonary arteries, as seen in thromboembolic disease or large vessel vasculitis. It is important for the radiologist to understand the radiological manifestations of these disorders, as early recognition would be of significant benefit in their diagnosis and treatment.
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Affiliation(s)
- Anant S Krishnan
- Department of Radiology, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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24
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Katabathina VS, Restrepo CS. Infectious and Noninfectious Aortitis: Cross-Sectional Imaging Findings. Semin Ultrasound CT MR 2012; 33:207-21. [DOI: 10.1053/j.sult.2011.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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25
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Histopathologic Overlap between Fibrosing Mediastinitis and IgG4-Related Disease. Int J Rheumatol 2012; 2012:207056. [PMID: 22654916 PMCID: PMC3357960 DOI: 10.1155/2012/207056] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/16/2012] [Accepted: 02/20/2012] [Indexed: 12/21/2022] Open
Abstract
Fibrosing mediastinitis (FM) and IgG4-related disease (IgG4-RD) are two fibroinflammatory disorders with potentially overlapping clinical and radiological features. In this paper, we looked for histopathologic features of IgG4-RD and enumerated infiltrating IgG4-positive plasma cells within mediastinal tissue biopsies from FM patients. We identified 15 consecutive FM surgical mediastinal tissue biopsies between 1985 and 2006. All patients satisfied the clinical and radiological diagnostic criteria for FM. All patients had either serological or radiological evidence of prior histoplasmosis or granulomatous disease, respectively. Formalin-fixed paraffin-embedded tissue sections of all patients were stained for H&E, IgG, and IgG4. Three samples met the predefined diagnostic criteria for IgG4-RD. In addition, characteristic histopathologic changes of IgG4-RD in the absence of diagnostic numbers of tissue infiltrating IgG4-positive plasma cells were seen in a number of additional cases (storiform cell-rich fibrosis in 11 cases, lymphoplasmacytic infiltrate in 7 cases, and obliterative phlebitis/arteritis in 2 cases). We conclude that up to one-third of histoplasmosis or granulomatous-disease-associated FM cases demonstrate histopathological features of IgG4-RD spectrum. Whether these changes occur as the host immune response against Histoplasma or represent a manifestation of IgG4-RD remains to be determined. Studies to prospectively identify these cases and evaluate their therapeutic responses to glucocorticoids and/or other immunosuppressive agents such as rituximab are warranted.
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Hawtin KE, Roddie ME, Mauri FA, Copley SJ. Pulmonary sarcoidosis: the 'Great Pretender'. Clin Radiol 2010; 65:642-50. [PMID: 20599067 DOI: 10.1016/j.crad.2010.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 03/03/2010] [Accepted: 03/10/2010] [Indexed: 01/15/2023]
Abstract
Sarcoidosis has a wide spectrum of appearances within the thorax. This review will discuss and illustrate the range of pulmonary manifestations on high-resolution computed tomography and chest radiography, concentrating on atypical features and examples of sarcoidosis mimicking other lung diseases. All included cases have been histologically confirmed. Such variable imaging appearances should alert the radiologist to consider sarcoidosis as a differential diagnosis in the context of interstitial lung disease.
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Affiliation(s)
- K E Hawtin
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Abstract
Tracheobronchial imaging has undergone a major revolution since the advent of MDCT. The improved spatial and temporal resolution not only allows reformatting images that enhance the comprehension of disease before bronchoscopy or surgery, it has introduced newer techniques such as dynamic expiratory imaging to evaluate for tracheomalacia, which can be a subtle, but a confounding entity for patients and clinician alike. Tracheobronchial diseases can be arbitrarily divided into those that cause focal and diffuse narrowing and widening. Such groupings can help develop a practical approach in evaluating diseases of the central airways.
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Affiliation(s)
- Cylen Javidan-Nejad
- Section of Cardiothoracic Imaging, Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St. Louis, MO 63110, USA.
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Abstract
CONTEXT Not uncommonly, a surgical pathologist will be requested to review excised material, with a clinical diagnosis of cancer, in which no malignancy can be identified. Often, sampling may be the issue. However, different nonneoplastic processes may mimic cancer clinically and not be recognized histologically. These are commonly referred to as pseudoneoplasms and can involve the lung, pleura, and mediastinum. OBJECTIVE To review the most commonly encountered pseudoneoplasms of the thoracic cavity in surgical pathology and discuss the main differential diagnosis. DATA SOURCES Literature and personal review of cases with focus on inflammatory pseudotumors of the lung, organizing pneumonia, nodular lymphoid hyperplasia, apical cap, round atelectasis, and sclerosing mediastinitis with its pulmonary counterpart, hyalinizing granuloma. CONCLUSIONS When reviewing specimens that appear nondiagnostic for malignancy, it is important to consider one of these pseudoneoplasms in the differential diagnosis as they may explain the clinical and radiologic information.
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Affiliation(s)
- Eunhee Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
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29
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Mediastinal tuberculosis: An unusual clinical presentation. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-010-0004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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30
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Abstract
Tracheobronchial imaging has undergone a major revolution. The improved spatial and temporal resolution has introduced newer techniques such as dynamic expiratory imaging to evaluate for tracheomalacia. This article describes these techniques.
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Affiliation(s)
- Cylen Javidan-Nejad
- Section of Cardiothoracic Imaging, Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA.
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31
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Lima TDC, Marchiori E, Capone D, Barreto MM, Rodrigues RS, Zanetti G. Mediastinite fibrosante: relato de caso. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000500015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho é relatado o caso de uma mulher de 51 anos de idade, com dor torácica, dispneia e engurgitamento de vasos do tórax superior, sem evidências clínicas de doença granulomatosa. O estudo por imagem do tórax revelou massa mediastinal com calcificações, abordada por mediastinoscopia com biópsia. A análise histopatológica mostrou padrão inflamatório crônico sem etiologia definida, compatível com mediastinite fibrosante.
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Affiliation(s)
| | - Edson Marchiori
- Universidade Federal Fluminense; Universidade Federal do Rio de Janeiro, Brasil
| | - Domenico Capone
- Universidade do Estado do Rio de Janeiro; Universidade Federal do Rio de Janeiro, Brasil
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den Bakker MA, Oosterhuis JW. Tumours and tumour-like conditions of the thymus other than thymoma; a practical approach. Histopathology 2009; 54:69-89. [DOI: 10.1111/j.1365-2559.2008.03177.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Anatoliotakis N, Chisholm S, Moncur L, Ketty A, Cury J. A Hypotensive 22-Year-Old Man With Chest Pain, Cough, and an Abnormal Chest Radiograph. Chest 2009; 135:228-232. [DOI: 10.1378/chest.08-0752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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