Chronic Obstruction of the Superior Vena Cava due to Histoplasmosis

Abstract

Selective angiography and indicator-dilution curves were employed to illustrate the fuctional anatomy of the collateral circulation in two patients with chronic obstruction of the superior vena cava. In both, clinical and laboratory evidence favored an etiologic diagnosis of histoplasmosis. In case 1, the transit time via the main collateral venous pathway, which comprised the left superior intercostal, accessory hemiazygos and azygos veins, was found to be a little greater than 25 seconds. In case 2, the superior vena caval obstruction was incomplete, but there was an associated severe narrowing of the right pulmonary artery. Distortion of the indicator-dilution curves provided evidence for an increased bronchopulmonary anastomotic circulation to the right lung. These observations illustrate how radiographic and hemodynamic technics may usefully be combined to assess the effects of acquired diseases of the major blood vessels.

Chronic idiopathic pulmonary hilar fibrosis: A clinicopathological entity

“…A genetic factor is suggested by the findings of Comings et al (1967) who reported two brothers, one developing orbital pseudotumour and retroperitoneal fibrosis and the other sclerosing mediastinitis which was followed by the development of orbital pseudotumour and Riedel's thyroditis. The role of infective granulomata, especially histoplasmosis, in producing mediastinal fibrosis has been stressed by many workers (Kunkel et al, 1954;Salyer et al, 1959;Marshall, Edmundowicz, and Andrews, 1964;Fifer, Woellner, and Gordon, 1955). In one of the patients described in our paper, organisms resembling Histoplasma capsulatum were identified in the biopsy specimen.…”

Pulmonary Venous and Arterial Hypertension due to Chronic Fibrous Mediastinitis

“…Local pulIoMary artery obstruction, functionally resembling coarctation, has been described in a few cases."' 12 The absence of a characteristic murmur and the lack of obstruction of major pulmonary arteries on angiography is strong evidence against this possibility. Furthemore, the microscopic appearance of the distal pulmonary vessels in the lung biopsy show the marked medial hypertrophy associated with pulmonary arteriolar hypertension.18…”