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Shin, Kim, Park, Park, Park, Soon, Lee, Im, Jeon, Jung, Jeong, Choi, Kang, Choi, Hong, and Kim: Localized Fibrosing Mediastinitis with Superior Vena Caval(SVC) Syndrome
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 63(4): 387-391.

Published online: 31 October 2007

DOI: https://doi.org/10.4046/trd.2007.63.4.387

Localized Fibrosing Mediastinitis with Superior Vena Caval(SVC) Syndrome

Sang Yun Shin, M.D.1, 5, Beom Kyung Kim, M.D.1, 5, Byung Hoon Park, M.D.1, 5, Seon Cheol Park, M.D.1, 5, Jun Chul Park, M.D.1, 5, Myoung Kyun Soon, M.D.1, 5, Seung Yul Lee, M.D.1, 5, Eui Im, M.D.1, 5, Han Ho Jeon, M.D.1, 5, Kyung Soo Jung, M.D.1, 5, Jae Heon Jeong, M.D.1, 5, Yu Ri Choi, M.D.1, Kyoung Hoon Kang, M.D.2, Yoon Jung Choi, M.D.3, Yong Kook Hong, M.D.4, Chong Ju Kim, M.D.1

1Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

2Department of Thoracic surgery, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

3Department of Pathology, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

4Department of Radiology, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Address for correspondence: Chong Ju Kim, M.D. Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, #1232, Paeksokdong, Ilsan-donggu, Koyang-shi, Kyunggi-do, 410-719, Korea. Phone: 82-31-900-0237, Fax: 82-31-900-0343, kom2d@netsgo.com

Received 7 August 2007       Accepted 7 September 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Fibrosing mediastinitis is a rare disease that is characterized by the proliferation of dense fibrous tissue of the mediastinum. The pathogenesis of fibrosing mediastinitis is unknown in most cases. However, histoplasmosis, tuberculosis, autoimmune disease, radiation therapy, and other idiopathic fibroinflammatory diseases have been implicated in some cases. Most clinical features are related to an obstruction or compression of the mediastinal structure. Fibrosing mediastinitis is often progressive and occurs diffusely throughout the mediastinum. We encountered a case of fibrosing mediastinitis of a very focal lesion without evidence of mediastinal involvement. The condition was confirmed by biopsy and graft bypass surgery was performed because of SVC syndrome.

Keywords: Fibrosing mediastinitis, Superior vena caval syndrome

Figures and Tables

Figure 1
Engorged external jugular vein (A) and collateral vessels on the anterior chest wall and abdomen (B). After graft bypass, vein engorgements were improved (C).
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Figure 2
Initial chest PA shows cicatricial atelectasis and multiple cavities on left upper lung.
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Figure 3
In initial CT scans, about 3.5 × 2 cm sized ill defined infiltrative lesion was observed on SVC. SVC was totally obstructed by this lesion(arrow).
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Figure 4
Focal dense fibrous tissue compressed SVC at the junction of right innominate vein (4A, arrow). Within right inominate vein and right atrium, a 10 mm Gore-tex® graft used to bypass the obstruction site (4B).
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Figure 5
Dense collagenized fibrosis containing several chronic inflammatory cells and dark anthracotic pigmentation. Hematoxylin and Eosin stain. (5A: ×100, 5B: ×200).
trd-63-387-g005

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