CRA20 TRAPPED IN MEDIASTINUM: FIBROSING MEDIASTINITIS: – A CASE REPORT

Mathivanan Suppiah 1, Chan Tha Hing 1 Arvindran Alaga1
1. Respiratory department, Hospital Sultanah Bahiyah, Kedah, Malaysia

Introduction:

Fibrosing mediastinitis (FM) is a rare and severe condition characterized by an increased proliferation of fibrous tissue in the mediastinum. This can result in the compression of mediastinal structures like the trachea, esophagus, and major blood vessels. The cause is usually associated with previous infections, like histoplasmosis, though idiopathic cases have also been recorded.

Objective:

We are presenting a case of fibrosing mediastinitis due to its rarity, discussing its clinical features diagnostic difficulties and possible future complication

Case report:

A 19-year-old female presented with a cough and left-sided hand numbness for the past year. No stridor and dysphagia. Physical examination showed no palpable neck mass.  Her neck x-ray revealed a left neck mass. CECT of the neck and thorax showed diffuse soft tissue mass in the left upper mediastinum measuring 3.7cm x 3.4cm x 5.5 cm with deviation of trachea to the right side, associated with vocal cord paralysis. She underwent a series of procedures such as linear EBUS and mediastinoscopy. Her histopathology result is consistent with fibrosing mediastinitis/ sclerosing mediastinitis with no evidence of malignancy. Her serum alpha-fetoprotein, β HCG, and LDH levels were normal. Her HIV, IGRA and sputum AFB results were negative as well.  Currently, the patient is keeping well and does not have any new or worsening symptoms.

Conclusion:

Fibrosing mediastinitis is an uncommon and complicated condition that necessitates a high index of suspicion for diagnosis to avoid unnecessary invasive procedures. Multidisciplinary management, which encompasses both medical and surgical methods, is often necessary to manage symptoms to improve patient outcomes.