A Case of Fibrosing Mediastinitis With Obstruction of Superior Vena Cava and Downhill Esophageal Varices

Abstract

Fibrosing mediastinitis (FM) is an excessive fibrotic reaction that occurs in the mediastinum and may lead to compression of mediastinal structures (especially vascular or bronchial). In the present study we describe the first case report of FM, in a patient who developed downhill esophageal varices and bleeding, which was secondary to superior vena cava obstruction.

Bleeding ‘downhill’ esophageal varices associated with benign superior vena cava obstruction: case report and literature review

“…2009, UK [14]Central venous catheter9Angioplasty (2), angioplasty and superior vena cava stenting (2), sclerotherapy and superior vena cava stenting (1), surgical vascular reconstruction (1), removal of central venous catheter (1), supportive care (1)Pashankar et al 1999, Canada [15], Mikkelson at al. 1963, USA [16], Savoy et al 2004, USA [17], Sundermann et al 1960, Germany [18], Johnson et al 1978 Canada [19]Thoracic Malignancy5Sclerotherapy (1), band ligation and superior vena cava stenting (1), surgical resection of cancer (1), supportive care (1), not reported (1)Yasar et al 2015, Turkey [20], Basaranoglu et al 1999, Turkey [21], Glanz et al 1982, USA [22], Pugliese 1973, USA [23], Snodgrass et al 1961, USA [24]Mediastinal Fibrosis5Conservative (2), steroids (1), Sengstaken-Blakemore tube (1), not reported (1)Papazian et al 1983, France [25], Palmer et al 1952, USA [26]Superior vena cava obstruction (not otherwise specified)4Conservative (3), not reported (1)Ibis et al 2007, Turkey [27], Fleig et al 1982, USA [28], Kelly et al 1982, USA [29]Thyroid goiter3Band ligation (1), Sengstaken-Blakemore tube (1), surgical resection of thyroid goiter (1)Tavakkoli at al. 2006, Iran [30], Ichikawa et al 1991, Japan [31]Behcet’s syndrome2Band ligation (1), supportive care (1)Calderwood et al 2008, USA [32], Maton et al 1985, USA [33]Upper extremity DVT2Band ligation, angioplasty, and superior vena cava stenting (1), conservative (1)Tincani et al 1998, Italy [34]Cirrhosis1Diagnosis at autopsyMalloy et al 2013, USA [35]Post Fontan cardiac surgery1Angioplasty and superior vena cava stentingTsokos et al 1998, Germany [36]Post thyroidectomy1SclerotherapyAreia et al 2006, Portugal [2]Pulmonary hypertension1Supportive carePillai et al 2013, USA [4]Hemodialysis reliable outflow (HeRO) graft associated1Band ligationMartorell et al 1955, Spain [37]<...>…”

A case of mediastinal fibrosis due to radiotherapy and ‘downhill’ esophageal varices: a rare cause of upper gastrointestinal bleeding

“…From a search of Pubmed using the terms 'downhill varices and bleeding', only one case of hemorrhagic downhill varices due to MF was identified [5]. Here, we present a second case of bleeding from downhill varices caused by MF, in a patient with a history of radiotherapy for mediastinal lymphadenopathy sixteen years previously.…”

Fibrosing Mediastinitis

“…1 The pliability and a low intraluminal pressure of the superior vena cava (SVC) makes it susceptible to compression and/or obstruction; 10 SVC obstruction often presents with nasal congestion, headaches, facial and upper chest congestion, and upper gastrointestinal bleeding from esophageal varices. 1,11 Fibrotic stenosis of the pulmonary artery can mimic thromboembolic obstruction. 12 Pulmonary vein constriction causes symptoms of pulmonary vascular congestion.…”