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Mediastinal fibrosis

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Chronic mediastinal inflammation, also known as idiopathic mediastinal fibrosis, is more complicated. It is known that tuberculosis, histoplasmosis, actinomycetes, sarcoidosis, syphilis, post-traumatic mediastinal hemorrhage, and drug poisoning can cause mediastinal fibrosis. It may also be related to autoimmunity. The cause of some patients is unknown.

Cause

Cause

(1) Causes of the disease:

It is known that tuberculosis, histoplasmosis, actinomycetes, sarcoidosis, syphilis, post-traumatic mediastinal hemorrhage, and drug poisoning can cause mediastinal fibrosis. It may also be related to autoimmunity. The cause of some patients is unknown.

(2) Pathogenesis:

The disease progresses slowly, forming a dense fibrous tissue in the mediastinum, which is flaky or lumpy. Occurs in the upper middle of the anterior mediastinum. Mainly invade the superior vena cava, innominate vein or azygous vein to cause stenosis or obstruction, other organs such as large pulmonary blood vessels or esophagus, trachea, bronchus can also be affected. A small number of patients can have both cervical fibrosis and retroperitoneal fibrosis.

Examine

an examination

Related inspection

Thoracic fluoroscopy, duodenal barium meal, angiography

Such as dysphagia, cough, shortness of breath, pulmonary artery pressure caused by increased pulmonary artery pressure. Involvement of the pulmonary veins can lead to pulmonary vascular congestion, hemoptysis, occasional compression of the phrenic nerve caused by diaphragmatic paralysis, oppression of the recurrent laryngeal nerves, hoarseness and so on.

In addition to relying on clinical manifestations and imaging changes, mediastinal biopsy (open chest biopsy or mediastinal biopsy) is of great value.

Diagnosis

Differential diagnosis

The disease should be differentiated from the superior vena cava obstruction caused by the disease. The superior vena cava syndrome caused by this disease, the patient does not have fever, and the erythrocyte sedimentation rate is normal. The diagnosis of this disease and central or mediastinal lung cancer, as well as malignant mediastinal tumors, is not difficult in the obvious tumor, but can be confused in the early stage, sometimes misdiagnosed as allergic reaction, angioedema, right heart failure, or even chronic narrowing. Sexual pericarditis and so on.

The disease is usually asymptomatic in the early stage, but it can gradually appear symptoms of adhesion or compression of the mediastinum, mainly for superior vena cava syndrome, increased venous pressure, edema of the head, face, neck and upper extremities, jugular vein filling, upper side of the chest wall The circulatory vein is dilated. The patient has symptoms such as headache, dizziness, difficulty breathing, and cyanosis. Due to the establishment of the collateral circulation, the obstruction can generally be gradually reduced, and the symptoms can be improved or disappeared. Lesions involving other organs can cause corresponding symptoms of obstruction in various organs. Such as dysphagia, cough, shortness of breath, pulmonary artery pressure caused by increased pulmonary artery pressure. Involvement of the pulmonary veins can lead to pulmonary vascular congestion, hemoptysis, occasional compression of the phrenic nerve caused by diaphragmatic paralysis, oppression of the recurrent laryngeal nerves, hoarseness and so on.