Letter to the EditorUnilateral pulmonary edema due to pulmonary venous obstruction from fibrosing mediastinitis
Introduction
Fibrosing mediastinitis is rarely met; moreover, vascular obstruction due to this process is an uncommon condition with involvement of the superior vena cava usually resulting in clinical manifestations. A few cases of pulmonary artery involvement have also been reported [1], [2], [3]; narrowing or even occlusion of the major pulmonary veins is one of the less commonly known and most insidious vascular complication of this disease, always followed by diagnostic difficulties [2], [4], [5], [6], [7], [8], [9]. We report on an 18-year-old male with both pulmonary artery and pulmonary veins obstruction, causing unilateral pulmonary edema, due to fibrosing mediastinitis surgically confirmed after a long history of symptoms and diagnostic procedures.
Section snippets
Case report
An 18-year-old white male was admitted to the Intensive Care Unit because of severe dyspnea, hypoxemia and hemoptysis. His past medical history started at 4 years of age when he was found to have a positive tuberculin skin test with a normal chest X-ray. He was given isoniazide and rifampicine for 1 year. From the age of 9 onwards he experienced recurrent episodes of upper respiratory track “infections” with non-productive cough and wheezing which was felt to be consistent with “asthma”. Two
Discussion
Fibrosing mediastinitis is a rare clinical entity, the manifestations of which depend upon the structures of the mediastinum involved. Vascular obstruction due to fibrosing mediastinitis is an uncommon condition; superior vena cava obstruction is the most commonly reported as it is easily diagnosed. Pulmonary artery compression has also been reported in a few patients since the first report [3]; pulmonary vein occlusion is rare and the most insidious manifestation. Clinical manifestation is
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