Chronic Mediastinitis

Mark Berry

Key Points

  • Chronic mediastinitis is most commonly associated with fungal or mycobacterial infections and encompasses a spectrum of inflammation from a chronic granulomatous process to dense fibrosis.
  • The inflammatory process can cause focal or diffuse encroachment or occlusion of mediastinal structures.
  • Symptoms of chronic mediastinitis are secondary to the compromised structure(s).
  • Medical therapy with antifungal therapy or anti-inflammatory agents such as steroids have been reported to have variable beneficial therapeutic effects in reversing or resolving the inflammatory process.
  • Surgery often plays a role in establishing a diagnosis, as distinguishing the benign chronic mediastinitis process from a neoplastic or malignant process by clinical and radiographic features alone can be difficult.
  • Both surgical and endovascular therapies can be required to palliate symptoms due to significantly compressed organs.
  • Therapy with the anti B-lymphocyte agent rituximab has also shown promise in terms of clinical and radiographic responses and can be discussed in a multi-disciplinary setting for symptomatic patients as an adjunct or alternative to an invasive procedure.

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