A 41-year-old Caucasian male presented with the chief complaint of intermittent syncope for 8 years. Syncope was observed with bending over, crouching, or standing up rapidly and was accompanied by 8 years of night sweats and 3 days of cough with hemoptysis. Past medical history was notable for asthma (diagnosed 18 years ago) and two prior episodes of “pneumonia.” The patient was born and raised in Tennessee and had worked as an agricultural field worker in California Central Valley and Iowa for over a decade before moving to San Diego. His physical exam, including vital signs, lung and heart exam were unremarkable, as was his complete blood count and serum chemistries. PPD skin testing and induced sputum smears for AFB were both negative, and sputum cultures only revealed rare yeast. Plain films of the chest suggested the presence of a right hilar mass. Chest CT scan demonstrated a 4.1 cm right anterior paratracheal mass with partial calcification that occluded the superior vena cava. Calcified bilateral mediastinal lymphadenopathy, splenic calcifications, and abdominal wall varices were also observed. CT angiogram demonstrated narrowing of the left main pulmonary artery to a minimum diameter of 7.6 mm. A transthoracic echocardiogram revealed normal biventricular function and no evidence of pulmonary hypertension. We discuss the differential diagnosis of fibrosing mediastinitis, evaluate potential mechanisms for hemodynamic compromise, and discuss various medical and surgical treatment options available for this disease.
California Thoracic Society, Western Regional Meeting, 2006.
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