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

Yang, Suqiao; Wang, Jianfeng; Li, Jifeng; Huang, Kewu; Yang, Yuanhua

doi:10.1177/03000605211010073

Cited by 8 publications

(7 citation statements)

References 35 publications

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“…When a CEH develops in the mediastinum, compression of the right ventricle causes RVOT stenosis, resulting in an elevated RVP. In addition, PH may also occur due to external compression of the pulmonary artery; PH due to compression of the pulmonary artery and vein by fibrotic mediastinitis has been previously reported (10). Intrathoracic CEHs are known to cause tracheal and oesophageal compression and consequent aspiration pneumonia (11) and oesophageal transit obstruction (12).…”

Section: Discussionmentioning

confidence: 99%

Chronic Expanding Haematoma Causing Stenosis of the Right Ventricular Outflow Tract and Pulmonary Hypertension

et al. 2023

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A chronic expanding haematoma (CEH) is an encapsulated mass that gradually increases in size from repeated internal bleeding and neovascularization. We herein report a 69-year-old man who was admitted with dyspnoea on exertion after undergoing thymic carcinoma resection 17 years ago. Chest computed tomography showed a heterogeneous mass in the anterior mediastinum and compression of the right ventricle, and pulmonary artery. Right cardiac catheterisation revealed pulmonary hypertension that was relieved after resection of the diagnosed CEH mass. This report highlights the mechanism underlying anterior mediastinal CEH-induced stenotic compression of the right ventricle-pulmonary artery outflow and subsequent pulmonary hypertension.

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Section: Discussionmentioning

confidence: 99%

Chronic Expanding Haematoma Causing Stenosis of the Right Ventricular Outflow Tract and Pulmonary Hypertension

et al. 2023

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“…However, among the 36 patients with PH-FM recruited in this study, 31 (86%) had pleural effusions and 19 (53%) were bilaterally afflicted, which agrees to the notion that the pleural effusion in the PH-FM patients was mainly caused by pulmonary vein stenosis (PVS). 9 , 21 Indeed, among the 30 patients with FM-caused PVS recruited in our prior study, 19 suffered from refractory pleural effusion; Furthermore, 17 out of the 19 patients with refractory pleural effusion were relieved by pulmonary vein angioplasty. 21 Admittedly, the PH-induced RHF is also involved to varying extents in the formation of pleural effusion in the patients with PH-FM.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 The protruding proliferative fibrotic tissues compress or encroach on the mediastinal structures, including bronchus, esophagus, vena cava, and pulmonary vasculature, leading to atelectasis, superior vena cava syndrome (SVCS), PH, and pleural effusion. 8,9 Chest X-ray radiography (CXR) is an inexpensive and convenient examination approach for PH with availability and accessibility in conventional clinical settings. 10 Previous study indicated that CXR features, including FM dyad (prominent main pulmonary artery and atelectasis) and FM triad (the dyad plus refractory pleural effusion), are important diagnostic clues for PH-FM.…”

Section: Introductionmentioning

confidence: 99%

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Chest X-ray features facilitate screening for pulmonary hypertension caused by fibrosing mediastinitis

Zhou

Chen

et al. 2022

Therapeutic Advances in Chronic Disease

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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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“…Although no publications clearly demonstrate the association between pulmonary artery stenosis/atresia and refractory pleural effusion, there are several case reports for adults in the literature. One of them is a refractory pleural effusion that developed on the left hemithorax as a result of pulmonary artery stenosis due to fibrosing mediastinitis in a 70-year-old man (16). However, there is no case involving this situation in the neonatal and infant age group.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography Guided Percutaneous Pleural Effusion Drainage in Neonates and Infants: A Single-Center Experience

Kesim¹,

Ozen²

2022

Kırıkkale Üniversitesi Tıp Fakültesi Dergisi

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Objective: This study aimed to investigate the possible complications, outcomes and course of ultrasonography (USG)-guided percutaneous pleural effusion drainage (PEPED) treatment with underlying etiology of effusion in neonates and infants. Material and Methods: In 31 patients aged 0-2 years hospitalized in the neonatal or pediatric intensive care unit, 45 catheters were inserted for USG-guided PEPED in a total of 40 sessions. Of these, a 6.3F 25 cm pigtail drainage catheter was inserted in 23 (57.5%) of our patients using the Seldinger method and in 17 (42.5%) using the trocar method. The sample fluid was biochemically classified as transudate, exudate, empyema and chylothorax. The duration of inserted catheter and type of fluid was studied along with etiological reasons for effusions. Results: Of our 31 patients, 17 were male (54.8%) and 14 were female (45.2). The weeks of birth ranged from 25.1 to 41 weeks, with a mean of 35.55±4.22 weeks. The retention time of drainage catheters ranged from 1 to 18 days, with a mean of 6.5±4.02 days. We compared the retention time of inserted catheters between different preterm and mature groups. Besides, the various fluid characters in the postoperative patient group were compared in the context postoperative day period. Conclusion: Catheter dwell time does not change with different levels of neonatal maturity. In neonates and infants with a history of surgery, the effusion transforms into chylothorax from hemothorax over time. Bedside USG-guided PEPED treatment for refractory pleural effusion in neonates and infants is highly safe and effective with low complication rates.

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

Cited by 8 publications

References 35 publications

Chronic Expanding Haematoma Causing Stenosis of the Right Ventricular Outflow Tract and Pulmonary Hypertension

Chronic Expanding Haematoma Causing Stenosis of the Right Ventricular Outflow Tract and Pulmonary Hypertension

Chest X-ray features facilitate screening for pulmonary hypertension caused by fibrosing mediastinitis

Ultrasonography Guided Percutaneous Pleural Effusion Drainage in Neonates and Infants: A Single-Center Experience

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