A Low Cellular Sclerosis of Anterior Mediastinum
CT-guided Biopsy with Hydrodissection of this Rare Entity - Case Report
DOI:
https://doi.org/10.59667/sjoranm.v3i1.10Keywords:
CT-guided biopsy, low cellular mediastinal sclerosis, sclerosing mediastinitis, aortic arch mass, retrosternal pleural hydrodissectionAbstract
Conducting a CT-guided interventional procedure involving retrosternal pleural hydro-dissection of the juxta-aortic anterior mediastinum under local anesthesia revealed a rare histopathological condition known as benign mediastinal sclerosis. This challenging CT-guided intervention within the anterior mediastinum is scarcely documented in the existing scientific literature. In this presentation, we share our case along with relevant clinical data. What makes this case distinctive is that the clinicians initially questioned the representativeness of the biopsy sample we obtained. Consequently, an additional sample was acquired through a highly invasive video-assisted mediastinoscopy procedure under intubation anesthesia. Remarkably, this second sample yielded the same histopathological result.
Mediastinal sclerosis is an exceedingly rare condition, often referred to as the "burnt-out" stage of sclerosing mediastinitis. While infectious etiologies are frequently identified (Tab.1), the majority of cases remain idiopathic [23].
References
References
Maalouf N, Abou Mrad M, Lavric D, Vasileva L, Mahnken AH, Apitzsch J. Safe Zone to Avoid Pneumothorax in a CT-Guided Lung Biopsy. J Clin Med 2023;12(3). DOI: https://doi.org/10.3390/jcm12030749
Zhang X, Zhang S, Wang J, et al. Comparison of fibrosing mediastinitis patients with vs. without markedly increased systolic pulmonary arterial pressure: a single-center retrospective study. BMC Cardiovasc Disord 2022;22(1):134. DOI: https://doi.org/10.1186/s12872-022-02567-z
Wang A, Su H, Duan Y, et al. Pulmonary Hypertension Caused by Fibrosing Mediastinitis. JACC Asia 2022;2(3):218-234. DOI: https://doi.org/10.1016/j.jacasi.2021.11.016
Rawitzer J, Langehegermann L, Aigner C, Repnik U, Schonfeld A, Theegarten D. [Mediastinal pseudotumor-necrotizing and sclerosing medias-tinitis with pseudomembranes]. Pathologie (Heidelb) 2022;43(4):311-316. DOI: https://doi.org/10.1007/s00292-022-01059-3
Panagopoulos N, Leivaditis V, Kraniotis P, Ravazoula P, Koletsis E, Dougenis D. Sclerosing Mediastinitis Causing Unilateral Pulmonary Edema Due to Left Atrial and Pulmonary Venous Compression. A Case Report and Literature Review. Braz J Cardiovasc Surg 2019;34(1):85-92 DOI: https://doi.org/10.21470/1678-9741-2018-0067
Rettenbacher T, Petrova-Schumann K, Brunner-Palka M, Brunner-Veber A, Pototschnig C, Gruber J. IgG4-Related Sclerosing Mediastinitis: Report of a Case with Distinct Ultrasound Findings. Ultrasound Int Open 2017;3(3):E125-E127 DOI: https://doi.org/10.1055/s-0043-110477
Giorgadze T, Koizumi JH, Ronen S, Chaump M, Magro CM. Postradiation-associated sclerosing mediastinitis diagnosed in fine needle aspiration specimen: A cytological-pathological correlation. Ann Diagn Pathol 2017;27:43-47. DOI: https://doi.org/10.1016/j.anndiagpath.2017.01.004
Bharadwaj R, Madakshira MG, Bharadwaj P, Sidhu HS. Sclerosing Mediastinitis Presenting as Complete Heart Block. J Clin Diagn Res 2017;11(5):ED12-ED14. DOI: https://doi.org/10.7860/JCDR/2017/26349.9786
Oka S, Uramoto H, Yamada S, Tanaka F. Sclerosing mediastinitis of unknown origin: Report of a case. Int J Surg Case Rep 2015;10:5-7 DOI: https://doi.org/10.1016/j.ijscr.2015.03.013
Chatterjee D, Bal A, Singhal M, Vijayvergiya R, Das A. Fibrosing mediastinitis due to Aspergillus with dominant cardiac involvement: report of two autopsy cases with review of literature. Cardiovasc Pathol 2014;23(6):354-7 DOI: https://doi.org/10.1016/j.carpath.2014.05.005
Smolock CJ, Blackmon S, Garami Z, Hassoun HT. Endovascular management of carotid artery stenosis secondary to sclerosing mediastinitis. J Vasc Surg 2012;56(2):492-5 DOI: https://doi.org/10.1016/j.jvs.2012.01.058
Serraj M, Kamaoui I, El Marzguioui N, Amara B, El Biaze M, Tizniti S, Benjelloun MC. [Acute pulmonary edema, new complication of sclerosing mediastinitis]. Rev Pneumol Clin 2012;68(5):290-4 DOI: https://doi.org/10.1016/j.pneumo.2012.04.001
Afrin LB. Sclerosing mediastinitis and mast cell activation syndrome. Pathol Res Pract 2012;208(3):181-5 DOI: https://doi.org/10.1016/j.prp.2011.12.005
Onuki T, Ishikawa S, Matsuoka T, Iguchi K, Inagaki M. Dual-phase FDG-PET imaging shows suspected malignancy that histological examination later confirmed as sclerosing mediastinitis: report of a case. Ann Thorac Cardiovasc Surg 2011;17(3):304-6 DOI: https://doi.org/10.5761/atcs.cr.09.01533
Jain D, Fishman EK, Argani P, Shah AS, Halushka MK. Unexpected sclerosing mediastinitis involving the ascending aorta in the setting of a multifocal fibrosclerotic disorder. Pathol Res Pract 2011;207(1):60-2 DOI: https://doi.org/10.1016/j.prp.2010.05.010
Miyata T, Takahama M, Yamamoto R, Nakajima R, Tada H. Sclerosing mediastinitis mimicking anterior mediastinal tumor. Ann Thorac Surg 2009;88(1):293-5 DOI: https://doi.org/10.1016/j.athoracsur.2008.11.070
Inoue M, Nose N, Nishikawa H, Takahashi M, Zen Y, Kawaguchi M. Successful treatment of sclerosing mediastinitis with a high serum IgG4 level. Gen Thorac Cardiovasc Surg 2007; 55 (10):431-3 DOI: https://doi.org/10.1007/s11748-007-0154-2
Ikeda K, Nomori H, Mori T, Kobayashi H, Iwatani K, Yoshimoto K, Yoshioka M. Successful steroid treatment for fibrosing mediastinitis and sclerosing cervicitis. Ann Thorac Surg 2007; 83(3):1199-201 DOI: https://doi.org/10.1016/j.athoracsur.2006.09.034
Kang DW, Canzian M, Beyruti R, Jatene FB. Sclerosing mediastinitis in the differential diagnosis of mediastinal tumors. J Bras Pneumol 2006;32(1):78-83 DOI: https://doi.org/10.1590/s1806-37132006000100015
Shinkawa T, Nakajima M, Kishimoto T, et al. A case of idiopathic sclerosing mediastinitis in a 7-year-old Japanese boy. Eur J Pediatr 2005;164(5):302-5 DOI: https://doi.org/10.1007/s00431-005-1644-9
Toubai T, Akama H, Ichikawa K, et al. [Fever of unknown origin due to sclerosing mediastinitis]. Nihon Naika Gakkai Zasshi 2001;90(11):2275-8 DOI: https://doi.org/10.2169/naika.90.2275
St Krasopoulos G, Ibrahim M, Venn G. Sclerosing mediastinitis with aortic valve regurgitation and aortic root dilatation. J R Soc Med 2000;93(2):83 DOI:https://doi.org/10.1177/014107680009300212
Carretero Gracia JA, Alvarez Alegret R, Penalver Cuesta JC. [Chronic sclerosing mediastinitis: infrequent cause of unilateral diaphragmatic paralysis]. Arch Bronconeumol 2000;36(7):417-9 DOI: https://doi.org/10.1016/s0300-2896(15)30142-3
Dechambre S, Dorzee J, Fastrez J, Hanzen C, Van Houtte P, d'Odemont JP. Bronchial stenosis and sclerosing mediastinitis: an uncommon complication of external thoracic radiotherapy. Eur Respir J 1998;11(5):1188-90 DOI: https://doi.org/10.1183/09031936.98.11051188
Savelli BA, Parshley M, Morganroth ML. Successful treatment of sclerosing cervicitis and fibrosing mediastinitis with tamoxifen. Chest 1997;111(4):1137-40 DOI: https://doi.org/10.1378/chest.111.4.1137
Jacobs P, Stein D, Bornman PC, Bolding E, Close P, Cunningham S. Sclerosing Mediastinitis Masquerading As A Lymphoma. Hematology 1997;2(4):317-21 DOI: https://doi.org/10.1080/10245332.1997.11746351
Mole TM, Glover J, Sheppard MN. Sclerosing mediastinitis: a report on 18 cases. Thorax 1995;50(3):280-3 DOI: https://doi.org/10.1136/thx.50.3.280
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Copyright (c) 2023 Daniela Lavric, Frank Mosler, Maalouf Maalouf, Roua Ben Ayed, Gerd Nöldge, Andreas Mahnken, Jonas C. Apitzsch
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