Catheter based treatments for fibrosing mediastinitis

Erin A Fender; R Jay Widmer; Erica M Knavel Koepsel; John P Welby; Ryan Kern; Tobias Peikert; Haraldur Bjarnason; David R Holmes Jr

doi:10.1002/ccd.28152

Catheter based treatments for fibrosing mediastinitis

Catheter Cardiovasc Interv. 2019 Nov 15;94(6):878-885. doi: 10.1002/ccd.28152. Epub 2019 Feb 21.

Authors

Erin A Fender¹, R Jay Widmer², Erica M Knavel Koepsel³, John P Welby⁴, Ryan Kern⁵, Tobias Peikert⁵, Haraldur Bjarnason³, David R Holmes Jr¹

Affiliations

¹ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
² Department of Cardiovascular Diseases, Baylor Scott and White, Temple, Texas.
³ Department of Radiology, Mayo Clinic, Rochester, Minnesota.
⁴ Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota.
⁵ Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.

PMID: 30790443
DOI: 10.1002/ccd.28152

Abstract

Fibrosing mediastinitis is a rare, often debilitating and potentially lethal disease characterized by an exuberant fibroinflammatory response within the mediastinum. Patients typically present with insidious symptoms related to compression of adjacent structures including the esophagus, heart, airways, and cardiac vessels. Fibrosing mediastinitis is most often triggered by Histoplasmosis infection; however, antifungal and anti-inflammatory therapies are largely ineffective. While structural interventions aimed at alleviating obstruction can provide significant palliation, surgical interventions are challenging with high mortality and clinical experience with percutaneous interventions is limited. Here, we will review the presentation, natural history, and treatment of fibrosing mediastinitis, placing particular emphasis on catheter-based therapies.

Keywords: histoplasmosis; pulmonary artery stenosis; pulmonary artery stent; pulmonary vein stenosis; pulmonary vein stent.

Publication types

Review

MeSH terms

Adolescent
Adult
Aged
Airway Obstruction / diagnostic imaging
Airway Obstruction / microbiology
Airway Obstruction / mortality
Airway Obstruction / therapy*
Bronchoscopy* / adverse effects
Bronchoscopy* / instrumentation
Bronchoscopy* / mortality
Child
Endovascular Procedures* / adverse effects
Endovascular Procedures* / instrumentation
Endovascular Procedures* / mortality
Female
Histoplasmosis / diagnostic imaging
Histoplasmosis / microbiology
Histoplasmosis / mortality
Histoplasmosis / therapy*
Humans
Male
Mediastinitis / diagnostic imaging
Mediastinitis / microbiology
Mediastinitis / mortality
Mediastinitis / therapy*
Middle Aged
Pulmonary Veno-Occlusive Disease / diagnostic imaging
Pulmonary Veno-Occlusive Disease / mortality
Pulmonary Veno-Occlusive Disease / therapy*
Risk Factors
Sclerosis / diagnostic imaging
Sclerosis / microbiology
Sclerosis / mortality
Sclerosis / therapy*
Stenosis, Pulmonary Artery / diagnostic imaging
Stenosis, Pulmonary Artery / mortality
Stenosis, Pulmonary Artery / therapy*
Stents
Treatment Outcome
Young Adult

Supplementary concepts

Mediastinal Fibrosis