Balloon angioplasty or stent implantation for pulmonary vein stenosis caused by fibrosing mediastinitis: a systematic review

Abstract

Fibrosing mediastinitis (FM) is a very rare disease, often caused by histoplasmosis capsulatum, tuberculosis, sarcoidosis, autoimmunity and other diseases, such as IgG 4-related diseases. Fibrous structures in the mediastinum compress the pulmonary artery, pulmonary vein, superior vena cava, esophagus, trachea and cardiac vessels, leading to clinical symptoms. Drug therapeutic modality for pulmonary vein stenosis (PVS) caused by FM is palliative in essence and with limited efficacy, whereas surgical treatment causes high mortality. In recent years, catheter-based treatment to FM-caused PVS has emerged as a promising therapeutic modality, however, the safety and effectiveness of this modality remain unclear. Therefore, a systematic review on the safety and efficacy of the catheter-based treatment for PVS caused by FM was performed, in the hope to shed lights on the alternative therapeutic strategy to this fatal disease.

Refractory pleural effusion as a rare complication of pulmonary vascular stenosis induced by fibrosing mediastinitis: a case report and literature review

“…26,34 A recent systematic review showed that pulmonary vascular compression in patients with FM can cause pulmonary hypertension and refractory pleural effusion, but no detailed information was provided regarding the use of interventional therapy to relieve pleural effusion resulting from pulmonary vascular stenosis. 34 In our patient, the affected pulmonary vasculature was characterized by left-sided PVS and right-sided PAS. Dilation of the right pulmonary arteries can directly decrease PAP and redistribute the blood flow from the left to the right, thus decreasing the hydrostatic pressure of the left hemithorax.…”

“… 32 , 33 Restenosis appears to be the most common complication related to interventional treatment of FM-induced PVS and PAS, followed by hemoptysis. 26 , 34 …”

“…His prognosis seemed to be better than that described in most previously published cases using stents to treat FM-induced pulmonary vascular stenosis, which may be attributed to our patient’s continuous anticoagulant therapy. 32 , 34 Because of the variety of causes of pleural effusion and the complexity of its hemodynamic features, the specific steps of interventional procedures should be further clarified.…”

Idiopathic fibrous mediastinitis with refractory pleural effusion: a case report and literature review

“…Pleural effusion is a relatively rare complication of FM, and its pathogenesis may be attributed to the increased hydrostatic pressure caused by pulmonary vein stenosis and cardiac insufficiency secondary to pulmonary hypertension, which can manifest as either unilateral or bilateral pleural effusion. 16 , 17 Because of the different etiologies and mediastinal compression sites of FM, the nature of the pleural effusion can be exudative or leaky. During the first few decades, the patient may have only a mild cough and expectoration.…”

“…3 Because biopsies are invasive, FM can also be diagnosed according to the clinical manifestations and imaging findings; however, other mediastinal diseases must be excluded, especially bronchogenic carcinoma and lymphoproliferative diseases. 11 , 14 , 17 , 18 Thoracic contrast-enhanced CT is the first choice for diagnosing suspected FM. 19 On CT, FM usually presents as focal or diffuse attenuating infiltrative soft tissue lesions with or without calcification; these lesions most often involve the middle mediastinum and wrap around important mediastinal structures, exhibiting less involvement of the anterior and posterior mediastinum.…”