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Van Kalsbeek D, Anani AR, El-Kersh K. Pulmonary artery vasodilators for treatment of pulmonary hypertension complicating fibrosing mediastinitis. Respir Med Case Rep 2024; 49:102006. [PMID: 38559326 PMCID: PMC10978528 DOI: 10.1016/j.rmcr.2024.102006] [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: 08/12/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Fibrosing mediastinitis (FM) is a heterogeneous disease characterized by sclerosing fibrosis of mediastinal structures. Pulmonary hypertension (PH) may complicate the course of the disease and can contribute significantly to the morbidity of FM. Due to the rarity and complexity of the disease, evidence-based guidelines are not currently available, and the optimal treatment approach is unknown. Management approaches should be individualized, and current techniques are often unsatisfactory. Here, we present two cases of PH complicating FM that were managed using pulmonary artery vasodilator therapy with excellent hemodynamic response.
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Boulu X, Perrin H, Schmidt J, Renard C. Superior vena cava syndrome of unusual cause. Rev Med Interne 2024; 45:174-175. [PMID: 38395715 DOI: 10.1016/j.revmed.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/04/2023] [Accepted: 11/04/2023] [Indexed: 02/25/2024]
Affiliation(s)
- X Boulu
- Service de médecine interne, CHU Amiens-Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens-Picardie, 80054 Amiens, France.
| | - H Perrin
- Service de médecine interne, CHU Amiens-Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens-Picardie, 80054 Amiens, France
| | - J Schmidt
- Service de médecine interne, CHU Amiens-Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens-Picardie, 80054 Amiens, France
| | - C Renard
- Service de radiologie et imagerie médicale, CHU Amiens-Picardie, 80054 Amiens, France
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You YT, Zuo H, Li JM, Zhu XB, Zhang J, Fu WL, Huang ZS, Herth FJ, Fan Y. Mediastinal Cryobiopsy for Pathological Diagnosis of Fibrosing Mediastinitis-Associated Pulmonary Hypertension. Respiration 2024; 103:95-99. [PMID: 38272003 PMCID: PMC10871676 DOI: 10.1159/000535395] [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: 08/30/2023] [Accepted: 11/20/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Fibrosing mediastinitis is a benign but fatal disorder characterized by the proliferation of fibrous tissue in the mediastinum, causing encasement of mediastinal organs and extrinsic compression of adjacent bronchovascular structures. FM-associated pulmonary hypertension (FM-PH) is a serious complication of FM, resulting from the external compression of lung vessels. Pathologic assessment is important for etiologic diagnosis and effective treatment of this disease. CASE PRESENTATION A 59-year-old male patient presented at our hospital and was diagnosed with FM-PH. He declined surgical biopsy that is the reference standard for pathologic assessment, in consideration of the potential risks. Therefore, an endobronchial ultrasound examination was performed, which identified the subcarinal lesion. Under ultrasound guidance, four needle aspirations were carried out, followed by one cryobiopsy. Histopathological examination of transbronchial needle aspiration specimens was inconclusive, while samples from cryobiopsy suggested a diagnosis of idiopathic FM. Further immunophenotyping demonstrated the infiltration of lymphocytes, macrophages, and FOXP3-positive cells in FM-PH. CONCLUSION Mediastinal cryobiopsy might be a novel and safe option for FM-PH patients who are unwilling or unsuitable for surgical procedure.
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Affiliation(s)
- Ya-Ting You
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Hao Zuo
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jing-Meng Li
- Department of Cardiothoracic Surgery, The People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Xian-Bo Zhu
- Department of Otolaryngology Head and Neck Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jing Zhang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Wan-Lei Fu
- Department of Pathology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zan-Sheng Huang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Felix J. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ye Fan
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Zhang J, Ding M, Tang A, Cao Y. A rare sequelae of esophageal perforation: Fibrosing mediastinitis. Pulm Circ 2024; 14:e12329. [PMID: 38174161 PMCID: PMC10762865 DOI: 10.1002/pul2.12329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Fibrosing mediastinitis (FM) is a rare disease caused by different causes. If left untreated, the prognosis is poor. The common causes of FM are Tuberculosis and Histoplasma capsulatum infection. Esophageal perforation is also a rare condition that is often easily under- and mis-diagnosed due to the lack of specificity of symptoms. Here we report a case of FM caused by esophageal perforation.
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Affiliation(s)
- Jingwen Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital)LanzhouChina
| | - Mingwang Ding
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital)LanzhouChina
| | - Aiping Tang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital)LanzhouChina
| | - Yunshan Cao
- The Department of Cardiology, Pulmonary Vascular Disease Center (PVDC)Gansu Provincial HospitalLanzhouChina
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Song L, Zan C, Liang Z, Chen X, Li J, Ren N, Shi Y, Zhang M, Lan L, Li H, Yan M, Li J, Li S, Wu Z. Potential Value of FAPI PET/CT in the Detection and Treatment of Fibrosing Mediastinitis: Preclinical and Pilot Clinical Investigation. Mol Pharm 2023; 20:4307-4318. [PMID: 37486106 DOI: 10.1021/acs.molpharmaceut.3c00452] [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] [Indexed: 07/25/2023]
Abstract
Fibrosing mediastinitis (FM) is a rare proliferative disease within the mediastinum that leads to pulmonary hypertension, which has been regarded as a major cause of death. This study aims to evaluate the potential value of fibroblast activation protein inhibitor (FAPI)-PET/CT in the integration of diagnosis and treatment of FM through targeting FAPI in fibrosis rats and provide a theoretical basis for clinical management of FM patients. By performing a 18F-FAPI PET/CT scan, the presence of FAPI-avid in the fibrotic lesion was determined. Through a fibrosis rat model, 18F-FAPI-74 was used for lesion imaging and 177Lu-FAPI-46 was utilized to investigate the potential therapeutic effect on FM in vivo. In addition, biodistribution analysis and radiation dosimetry were carried out. With the 177Lu-FAPI-46 pharmacokinetic data of rats as the input, the estimated dose for female adults was computed, which can provide some useful information for the safe application of radiolabeled FAPI in the detection and treatment of FM in patients. Then, major findings on the use of FAPI PET/CT and SPECT/CT in FM were presented. 18F-FAPI-74 showed a high-level uptake in FM lesions of patients (SUVmax 7.94 ± 0.26), which was also observed in fibrosis rats (SUVmax 2.11 ± 0.23). Consistently, SPECT/CT imaging of fibrosis rats also revealed that 177Lu-FAPI-46-avid was active for up to 60 h in fibrotic lesions. In addition to this robust diagnostic performance, a possible therapeutic impact was evaluated as well. It turned out that no spontaneous healing of lesions was observed in the control group, whereas there was complete healing on day 9, day 11, and day 14 in the 30, 100, and 300 MBq groups, respectively. With a significant difference in the free of event rate in the Kaplan-Meier curve among four groups (P < 0.001), a dose of 300 MBq displayed the best therapeutic effect, and no obvious damage was observed in the kidney. Furthermore, organ-absorbed doses and an effective dose (0.4320 mSv/MBq) of 177Lu-FAPI-46 presumed for patients were assumed to give a preliminary indication of its safe use in clinical practice. In conclusion, 18F-FAPI-46 PET/CT can be a potentially valuable tool for the diagnosis of FM. Of note, 177Lu-FAPI-46 may be a novel and safe radiolabeled reagent for the integration of diagnosis and treatment of FM.
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Affiliation(s)
- Liwei Song
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
- Department of General Practice, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
| | - Chunfang Zan
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
- Shanxi Key Laboratory of Molecular Imaging, Shanxi Medical University, Taiyuan 030001, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Zhuang Liang
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
| | - Xufu Chen
- CAEA Center of Excellence on Nuclear Technology Applications for Nonclinical Evaluation for Radiopharmaceutical, Taiyuan 030001, China
- Shanxi Key Laboratory of Drug Toxicology and Drug for Radiation Injury, China Institute for Radiation Protection, Taiyuan 030001, China
| | - Jiahe Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
| | - Ning Ren
- Department of General Surgery, The Fifth People's Hospital of Datong, Datong 037006, China
| | - Yiwei Shi
- Department of Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
| | - Mengyuan Zhang
- Department of Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
| | - Lizhen Lan
- Department of General Practice, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
| | - Huiling Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
| | - Min Yan
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
| | - Jianguo Li
- CAEA Center of Excellence on Nuclear Technology Applications for Nonclinical Evaluation for Radiopharmaceutical, Taiyuan 030001, China
- Shanxi Key Laboratory of Drug Toxicology and Drug for Radiation Injury, China Institute for Radiation Protection, Taiyuan 030001, China
| | - Sijin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
- Shanxi Key Laboratory of Molecular Imaging, Shanxi Medical University, Taiyuan 030001, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Zhifang Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, China
- Shanxi Key Laboratory of Molecular Imaging, Shanxi Medical University, Taiyuan 030001, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan 030001, China
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Westhoff M, Hardebusch T, Litterst P, Breithecker A, Haas M, Kuniss M, Neumann T, Guth S, Wiedenroth CB. Successful simultaneous stenting of a pulmonary artery and vein in pulmonary vascular stenosis due to silicosis. Case report and literature review. Front Cardiovasc Med 2023; 10:1108768. [PMID: 37229232 PMCID: PMC10203551 DOI: 10.3389/fcvm.2023.1108768] [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: 11/26/2022] [Accepted: 03/16/2023] [Indexed: 05/27/2023] Open
Abstract
A 58-year-old patient was admitted to the emergency department due to severe respiratory insufficiency. Anamnesis revealed that the patient had experienced increasing stress dyspnea for a few months. Upon imaging, an acute pulmonary embolism was excluded, but peribronchial and hilar soft tissue proliferation with compression of central parts of the pulmonary circulation was found. The patient had a history of silicosis. The histology report showed tumor-free lymph node particles with prominent anthracotic pigment and dust depositions without evidence of IgG4-associated disease. The patient was administered steroid therapy and underwent simultaneous stenting of the left interlobular pulmonary artery and the upper right pulmonary vein. As a result, a significant improvement in symptoms and physical performance was achieved. The diagnosis of inflammatory or, in particular, fibrosing mediastinal processes can be challenging and important clinical symptoms must be taken into account, especially if the pulmonary vasculature is involved. In such cases, the possibility of interventional procedures should be examined in addition to drug therapy options.
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Affiliation(s)
- M. Westhoff
- Department of Pulmonology, Klinik für Pneumologie, Schlaf und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer, Germany
- Universität Witten/Herdecke University, Witten, Germany
| | - T. Hardebusch
- Department of Pulmonology, Klinik für Pneumologie, Schlaf und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer, Germany
| | - P. Litterst
- Department of Pulmonology, Klinik für Pneumologie, Schlaf und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer, Germany
| | - A. Breithecker
- Department of Radiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - M. Haas
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - M. Kuniss
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - T. Neumann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - S. Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - C. B. Wiedenroth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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Zhou M, Li B, Chen Y, Wang A, Zhu Y, Li Y, Su H, Fan J, Zhang Y, Cao Y. Chest X-ray features facilitate screening for pulmonary hypertension caused by fibrosing mediastinitis. Ther Adv Chronic Dis 2022; 13:20406223221143245. [PMID: 36583160 PMCID: PMC9793020 DOI: 10.1177/20406223221143245] [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: 07/20/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background Misdiagnosis and underdiagnosis of pulmonary hypertension caused by fibrosing mediastinitis (PH-FM) are considerably prevalent due to unspecific symptoms and as well as the lack of awareness of this fatal disease. Objectives The aim of this study was to evaluate the diagnostic accuracy of the chest X-ray (CXR) for screening the patients with PH-FM from those with pulmonary hypertension (PH). Design This was a retrospective observational cohort study. Methods The patients with suspected PH were recruited between October 2014 and October 2020. All the clinical data and CXR findings were collected. The sensitivity, specificity, and likelihood ratio of the CXR features were calculated. Logistic regression was used to identify the factors associated with the CXR characteristics and FM and to generate a prediction model. Finally, the diagnostic efficiency of the prediction model was evaluated using nomogram and internal validation. Results The patients with PH-FM (n = 36) and PH caused by the diseases other than FM (PH-non-FM, n = 62) were enrolled. The CXR features, including atelectasis, pleural effusion, consolidation, nodules, calcification, interlobular septal thickening, and interstitial reticulation, were more prevalent in patients with PH-FM than in those with PH-non-FM (all p < 0.05). Atelectasis had a specificity of 97%, a sensitivity of 50%, and a greater accuracy for diagnosing of PH-FM [area under the curve (AUC) = 0.720; 95% CI: 0.634-0.806] than the other factors did. The combination of tuberculosis, natural logarithmic NT-proBNP (lnBNP), atelectasis, pleural effusion, and prominent right heart border constituted a prediction model to distinguish the PH-FM from the PH-non-FM, with a sensitivity of 91.7% and a specificity of 83.9%. The model demonstrated good prediction performance by showing an AUC of 0.922 (95% CI: 0.861-0.983) in the internal validation. Conclusion In this study, atelectasis was the most specific and accurate CXR characteristic for identifying PH-FM in the PH patients. The combination of atelectasis, pleural effusion, prominent right heart border, tuberculosis, and lnBNP constituted a prediction model that distinguished the PH-FM patients from the PH-non-FM ones with good performance.
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Affiliation(s)
| | | | - Yaling Chen
- The First Clinical Medical College of Gansu
University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou,
China
| | - Aqian Wang
- Department of Cardiology, Pulmonary Vascular
Disease Center (PVDC), Gansu Provincial Hospital, Lanzhou, China
| | - Yining Zhu
- School of Mathematical Sciences, Fudan
University, Shanghai, China
| | - Yu Li
- Department of Radiology, The Seventh Affiliated
Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hongling Su
- Department of Cardiology, Pulmonary Vascular
Disease Center (PVDC), Gansu Provincial Hospital, Lanzhou, China
| | - Jingchun Fan
- Gansu University of Chinese Medicine, Lanzhou,
China
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