Fibrosing mediastinitis: 'haemoptysis in the Heartland

Fibrosing mediastinitis (FM) is an uncommon cause of haemoptysis, characterised by sclerosis of the mediastinum that may occur as an inflammatory sequela of histoplasmosis, lymphoma, sarcoidosis or an idiopathic process. Bleeding is predominantly due to concomitant collateral vessels and engorgement. However, the endobronchial findings obtained via flexible bronchoscopy are not clearly defined in the literature.1 Here, we present the case of a 41-year-old woman with no prior medical history who presented with a 2-month history of exertional dyspnoea and recurrent haemoptysis. Chest CT showed complete obstruction of the right inferior pulmonary vein and marked stenosis of the right superior pulmonary vein due to circumferential encasement by confluent soft tissues in the right infrahilar region (figure 1A–C). Flexible bronchoscopy showed a hyperaemic, oozing mucosa with a diffuse web-like microvasculature and extensive neovascularisation of the lower trachea and both mainstem bronchi (right>left) (figure 1D–E). Initially,...
Source: Thorax - Category: Respiratory Medicine Authors: Tags: Images in Thorax, Thorax Source Type: research