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Editorial - Journal of Pulmonology and Clinical Research (2021) Volume 4, Issue 6
A Review of Epidemiology, Diagnosis, and Management of Fibrosing Mediastinitis
Fibrosing Mediastinitis (FM) is a rare but increasingly recognized complication that has been mainly associated with chronic pulmonary histoplasmosis, granulomatous diseases, infections and autoimmune processes. Symptoms vary depending on compromised structures, mainly structures within the mediastinum. This review will focus on the etiology, clinical presentation and management of fibrosing mediastinitis based on multiple case series published to date. Fibrosing mediastinitis is a rare, mainly associated with histoplasmosis infections. Also associated with sarcoidosis, tuberculosis, malignancies as well as other autoimmune processes. Hallmark features include fibrosing sclerosis encompassing and compromising mediastinal structures, including inferior and superior vena cava, pulmonary artery and vein, esophagus and heart. Treatment approach depends on symptomology, structures involved and include medical management, surgical management and conservative/palliative options. Fibrosing Mediastinitis (FM) is a rare complication that has mainly been associated with histoplasmosis infections, however it can also be a complication of granulomatous infiltrative processes, including tuberculosis and sarcoidosis. The results of this condition can lead to significant symptom burden that require a unique approach to its management. We submit a comprehensive review concerning the natural history and management of fibrosing mediastinitis. Methods Database searches conducted during the initial review done via institutional database proxy. Access granted through shared agreement with medical education and partnering medical institution. The database search was conducted using the key terms "fibrosing mediastinitis" and "fibrosing plus histoplasmosis". These terms were chosen due to the specific nature and etiology of the presenting case. During this initial database search, over 600 articles identified. Further truncating done to eliminate articles not within the last 30 years. Exception made for early case studies. All articles cited were fully accessible electronically. Fifty total articles were screened with 28 articles directly cited in the preceding work. Further articles were eliminated due to relevancy. Fibrosing mediastinitis, although not well understood, is a sequalae or progression of an underlying infection or granulomatous disease. It has been highly associated with histoplasmosis especially in the United States (US). It has been described in case reports associated with other disease processes, including infectious causes such as blastomycosis, sarcoidosis, tuberculosis aspergillosis, mucormycosis and Accepted on 15 November, 2021 cryptococcosis. Some autoimmune causes have also been reported, including Bechet disease, rheumatoid arthritis and systemic lupus erythematosus. Other associated causes include adenocarcinoma of lung, Hodgkin's disease, and associated treatment with radiation therapy. There have been many postulated mechanisms including an abnormal immunological response to the infection or autoimmune process. It is thought that during this response, acellular collagen and fibrous tissue overwhelm the mediastinum, causing severe obstruction, compression and compromise of mediastinal structures.
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