Clinical Manifestations of Fibrosing Mediastinitis in Chinese Patients.
BACKGROUND
Fibrosing mediastinitis (FM) is a rare disease. FM is thought to be related to prior granulomatous mediastinal infection, such as histoplasmosis or tuberculosis. The majority of cases have been reported in endemic regions for histoplasmosis. The characteristics of cases of FM in China, where the prevalence of tuberculosis is high, have not been reported. We analyzed the clinical, imaging, and bronchoscopic features of Chinese patients with FM to promote awareness of this disease.


METHODS
Between January 2005 and June 2015, twenty patients were diagnosed with FM in our hospital. Medical records and follow-up data were collected. Imaging and biopsy findings were reviewed by radiologists and pathologists.


RESULTS
A total of 20 patients were analyzed (8 males and 12 females). The age ranged from 43 to 88 years with a mean age of 69.5 years. Previous or latent tuberculosis was found in 12 cases. Clinical symptoms included dyspnea (18/20), cough (17/20), expectoration (7/20), and recurrent pneumonia (3/20). Chest computed tomography scans showed a diffuse, homogeneous, soft tissue process throughout the mediastinum and hila with compression of bronchial and pulmonary vessels. Calcification was common (15/20). Pulmonary hypertension was present in 9 of 20 cases. Diffuse black pigmentation in the bronchial mucosa was frequently seen on bronchoscopy (12/13). The patients' response to antituberculosis treatment was inconsistent.


CONCLUSIONS
FM in Chinese patients is most likely associated with tuberculosis. Some characteristics of FM are different from cases caused by histoplasmosis.
Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Yan
Y
Hu
Department of Medical Imaging, Peking University First Hospital, Beijing 100034, China.
Jian-Xing
JX
Qiu
Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Ji-Ping
JP
Liao
Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Hong
H
Zhang
Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Zhe
Z
Jin
Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Guang-Fa
GF
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002681:China; D005260:Female; D006660:Histoplasmosis / Q000150:complications / Q000175:diagnosis; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D012598:Sclerosis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D014376:Tuberculosis / Q000175:diagnosis / Q000503:physiopathology