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Mediastinitis , Necrosis , Absceso Retrofaríngeo , Infecciones de los Tejidos Blandos , Humanos , Mediastinitis/diagnóstico por imagen , Mediastinitis/patología , Absceso Retrofaríngeo/diagnóstico por imagen , Infecciones de los Tejidos Blandos/patología , Masculino , Antibacterianos/uso terapéuticoRESUMEN
OBJECTIVE: The objective of this study was to explore the added value of spectral computed tomography (CT) parameters to conventional CT features for differentiating tuberculosis-associated fibrosing mediastinitis (TB-associated FM) from endobronchial lung cancer (EBLC). METHODS: Chest spectral CT enhancement images from 109 patients with atelectasis were analyzed retrospectively. These patients were divided into two distinct categories: the TB-associated FM group (n = 77) and the EBLC group (n = 32), based on bronchoscopy and/or pathological findings. The selection of spectrum parameters was optimized with the least absolute shrinkage and selection operator regression analysis. The relationship between the spectrum parameters and conventional parameters was explored using Pearson's correlation. Multivariate logistic regression analysis was used to build spectrum model. The spectrum parameters in the spectrum model were replaced with their corresponding conventional parameters to build the conventional model. Diagnostic performances were evaluated using receiver operating characteristic curve analyses. RESULTS: There was a moderate correlation between the parameters ã(L-AEFNIC) - ã(L-AEFC) (r= 0.419; p< 0.0001), ã(O-AEF40KeV) - ã(O-AEFC) (r= 0.475; p< 0.0001), [L-A-hydroxyapatite {HAP}(I)] - (L-U-CT) (r= 0.604; p< 0.0001), {arterial enhancement fraction (AEF) derived from normalized iodine concentration (NIC) of lymph node (L-AEFNIC), AEF derived from CT40KeV of bronchial obstruction (O-AEF40KeV), arterial-phase Hydroxyapatite (Iodine) concentration of lymph node [L-A-HAP(I)], AEF derived from conventional CT (AEFC), unenhanced CT value (U-CT)}. Spectrum model could improve diagnostic performances compared to conventional model (area under curve: 0.965 vs 0.916, p= 0.038). CONCLUSION: There was a moderate correlation between spectrum parameters and conventional parameters. Integrating conventional CT features with spectrum parameters could further improve the ability in differentiating TB-associated FM from EBLC.
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Neoplasias Pulmonares , Mediastinitis , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , Persona de Mediana Edad , Mediastinitis/diagnóstico por imagen , Mediastinitis/complicaciones , Estudios Retrospectivos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/complicaciones , Anciano , Esclerosis/diagnóstico por imagen , Esclerosis/complicaciones , Adulto , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagen , Broncoscopía/métodosRESUMEN
We present a case of descending necrotising mediastinitis (DNM) originating from a retropharyngeal abscess in a healthy early childhood patient. The patient had a history of fever, odynophagia and refusal to eat, followed by rapid deterioration of the clinical state. Cervicothoracic CT was performed, which revealed a right parapharyngeal abscess, extending to the mediastinum and occupying the retropharyngeal/visceral space, with gaseous content throughout this collection, associated with bilateral pleural effusion, aspects compatible with DNM. She started broad-spectrum antibiotic therapy and transoral drainage of the parapharyngeal and retropharyngeal collections was performed under general anaesthesia. She was admitted to the intensive care unit. The patient showed clinical, analytical and imaging improvement, having been transferred to the ear, nose and throat department, with favourable evolution. Early diagnosis of DNM by cervicothoracic CT and multidisciplinary approaches, including intensive care, broad-spectrum antibiotics and surgical intervention, are crucial to minimise the morbidity and mortality.
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Mediastinitis , Absceso Retrofaríngeo , Preescolar , Femenino , Humanos , Drenaje/métodos , Mediastinitis/diagnóstico por imagen , Mediastinitis/terapia , Mediastino/diagnóstico por imagen , Cuello , Necrosis/complicaciones , Absceso Retrofaríngeo/diagnóstico por imagen , Absceso Retrofaríngeo/terapiaRESUMEN
We report a case of descending necrotizing mediastinitis (DNM) in a 68-year-old male who presented in acute respiratory distress accompanied with anterior cervical neck swelling and pain with swallowing. Contrast enhanced computed tomography (CECT) of the neck demonstrated a large, peripherally enhancing retropharyngeal fluid and air collection that appeared to communicate with a fluid and air collection within the mediastinum. CECT of the chest demonstrated punctate foci of air and fat stranding along the anterior and superior mediastinum. Radiological evidence and the presence of necrosis on surgical debridement of the retropharyngeal abscess established the diagnosis of DNM. This case emphasizes the role of computed tomography (CT) in the diagnosis of DNM and demonstrates the utility of chest imaging in a high-risk patient who presents with a retropharyngeal abscess.
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Mediastinitis , Absceso Retrofaríngeo , Anciano , Humanos , Masculino , Drenaje , Mediastinitis/diagnóstico por imagen , Mediastinitis/etiología , Mediastinitis/cirugía , Cuello/diagnóstico por imagen , Necrosis/complicaciones , Radiografía , Absceso Retrofaríngeo/complicaciones , Absceso Retrofaríngeo/diagnóstico por imagen , Absceso Retrofaríngeo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Fibrosing mediastinitis (FM) is a rare proliferative disease within the mediastinum that leads to pulmonary hypertension, which has been regarded as a major cause of death. This study aims to evaluate the potential value of fibroblast activation protein inhibitor (FAPI)-PET/CT in the integration of diagnosis and treatment of FM through targeting FAPI in fibrosis rats and provide a theoretical basis for clinical management of FM patients. By performing a 18F-FAPI PET/CT scan, the presence of FAPI-avid in the fibrotic lesion was determined. Through a fibrosis rat model, 18F-FAPI-74 was used for lesion imaging and 177Lu-FAPI-46 was utilized to investigate the potential therapeutic effect on FM in vivo. In addition, biodistribution analysis and radiation dosimetry were carried out. With the 177Lu-FAPI-46 pharmacokinetic data of rats as the input, the estimated dose for female adults was computed, which can provide some useful information for the safe application of radiolabeled FAPI in the detection and treatment of FM in patients. Then, major findings on the use of FAPI PET/CT and SPECT/CT in FM were presented. 18F-FAPI-74 showed a high-level uptake in FM lesions of patients (SUVmax 7.94 ± 0.26), which was also observed in fibrosis rats (SUVmax 2.11 ± 0.23). Consistently, SPECT/CT imaging of fibrosis rats also revealed that 177Lu-FAPI-46-avid was active for up to 60 h in fibrotic lesions. In addition to this robust diagnostic performance, a possible therapeutic impact was evaluated as well. It turned out that no spontaneous healing of lesions was observed in the control group, whereas there was complete healing on day 9, day 11, and day 14 in the 30, 100, and 300 MBq groups, respectively. With a significant difference in the free of event rate in the Kaplan-Meier curve among four groups (P < 0.001), a dose of 300 MBq displayed the best therapeutic effect, and no obvious damage was observed in the kidney. Furthermore, organ-absorbed doses and an effective dose (0.4320 mSv/MBq) of 177Lu-FAPI-46 presumed for patients were assumed to give a preliminary indication of its safe use in clinical practice. In conclusion, 18F-FAPI-46 PET/CT can be a potentially valuable tool for the diagnosis of FM. Of note, 177Lu-FAPI-46 may be a novel and safe radiolabeled reagent for the integration of diagnosis and treatment of FM.
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Mediastinitis , Quinolinas , Femenino , Animales , Ratas , Tomografía Computarizada por Tomografía de Emisión de Positrones , Distribución Tisular , Mediastinitis/diagnóstico por imagen , Mediastinitis/tratamiento farmacológico , Radioisótopos de Galio , Fluorodesoxiglucosa F18RESUMEN
PURPOSE: Sclerosing mesenteritis (SM), a fibroinflammatory process of the mesentery, can rarely occur after immune checkpoint inhibitor (ICI) therapy; however, its clinical significance and optimal management are unclear. We aimed to assess the characteristics and disease course of patients who developed SM following ICI therapy at a single tertiary cancer center. METHODS: We retrospectively identified 12 eligible adult cancer patients between 05/2011 and 05/2022. Patients' clinical data were evaluated and summarized. RESULTS: The median patient age was 71.5 years. The most common cancer types were gastrointestinal, hematologic, and skin. Eight patients (67%) received anti-PD-1/L1 monotherapy, 2 (17%) received anti-CTLA-4 monotherapy, and 2 (17%) received combination therapy. SM occurred after a median duration of 8.6 months from the first ICI dose. Most patients (75%) were asymptomatic on diagnosis. Three patients (25%) reported abdominal pain, nausea, and fever and received inpatient care and corticosteroid treatment with symptom resolution. No patients experienced SM recurrence after the completion of corticosteroids. Seven patients (58%) experienced resolution of SM on imaging. Seven patients (58%) resumed ICI therapy after the diagnosis of SM. CONCLUSIONS: SM represents an immune-related adverse event that may occur after initiation of ICI therapy. The clinical significance and optimal management of SM following ICI therapy remains uncertain. While most cases were asymptomatic and did not require active management or ICI termination, medical intervention was needed in select symptomatic cases. Further large-scale studies are needed to clarify the association of SM with ICI therapy.
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Inhibidores de Puntos de Control Inmunológico , Mediastinitis , Neoplasias , Esclerosis , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Mediastinitis/diagnóstico por imagen , Mediastinitis/tratamiento farmacológico , Mediastinitis/inmunología , Esclerosis/diagnóstico por imagen , Esclerosis/tratamiento farmacológico , Esclerosis/inmunología , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Neoplasias/tratamiento farmacológico , Estudios Retrospectivos , Corticoesteroides/uso terapéuticoRESUMEN
Fibrosing mediastinitis is caused by a proliferation of fibrous tissue in the mediastinum with encasement of mediastinal viscera and compression of mediastinal bronchovascular structures. Pulmonary hypertension (PH) may occur as a severe complication of the disease. Herein, we report a patient diagnosed with fibrosing mediastinitis and pulmonary hypertension, whose imaging tests showed obstruction of right pulmonary artery and veins.
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Hipertensión Pulmonar , Mediastinitis , Venas Pulmonares , Humanos , Arteria Pulmonar/diagnóstico por imagen , Venas Pulmonares/diagnóstico por imagen , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/diagnóstico por imagen , Pulmón , Mediastinitis/diagnóstico , Mediastinitis/diagnóstico por imagen , FibrosisRESUMEN
We report a case of a 1-year-old girl where computed tomography (CT) angiography demonstrated presence of ill-defined heterogenous soft tissue thickening obliterating the mediastinal fat planes in right peri-hilar region and encasing the hilar right pulmonary artery and its segmental branches leading to marked narrowing with nonvisualization of the right-sided pulmonary veins. The case highlights the features of fibrosing mediastinitis as well as the role of CT angiography in the diagnosis and accurate depiction of the extent of involvement of the mediastinal vasculature and airways.
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Hipertensión Pulmonar , Mediastinitis , Femenino , Humanos , Lactante , Arteria Pulmonar/diagnóstico por imagen , Mediastinitis/diagnóstico por imagen , Mediastino/diagnóstico por imagenRESUMEN
INTRODUCTION: Fibrosing mediastinitis (FM) complicated with pulmonary hypertension (PH) has been considered as an important cause of morbidity and mortality. This study was designed to observe the possible effects of abnormal hemodynamics on patients by conducting a between-group comparison according to the presence of markedly increased systolic pulmonary arterial pressure (SPAP), so as to provide more information for clinical management. MATERIALS AND METHODS: Fifty-one patients with clinically diagnosed FM were divided in two groups (SPAP < 50 mmHg group; SPAP ≥ 50 mmHg group) and retrospectively included in the study. Data mainly including demographic factors, echocardiographic data, results of right heart catheter and computed tomography (CT) examination were retrieved from the medical database. Echocardiographic parameters pre- and post- balloon pulmonary angioplasty (BPA) treatment were also collected in 8 patients. RESULTS: Significant changes in cardiac structure, hemodynamics and cardiac function were detected in patients complicated with markedly increased SPAP. Patients in the SPAP ≥ 50 mmHg group had increased right heart diameter, right heart ratio and velocity of tricuspid regurgitation (VTR) (p < 0.05). Deteriorated right heart function was also observed. There was no significant difference in CT findings between the two groups, except that more patients in the SPAP ≥ 50 mmHg group had pleural effusion (p < 0.05). After primary BPA in 8 patients, improvement in the right atrium proportion was observed. CONCLUSIONS: Changes due to significantly increased SPAP in patients with FM include adverse structure and function of the right heart, but differences in CT findings were not significant. Echocardiography has advantages as a noninvasive tool for the evaluation of cardiac structure, function and hemodynamics in patients with FM.
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Presión Arterial , Mediastinitis , Humanos , Mediastinitis/diagnóstico por imagen , Mediastinitis/terapia , Estudios Retrospectivos , Esclerosis , SístoleRESUMEN
We herein report a 61-year-old man who sustained injury after a 2-m fall and developed mediastinitis. He presented to another hospital two days after the fall and was transferred to our hospital four days after the fall with a fever and dysphagia. Computed tomography revealed osteophytes on the second and third thoracic vertebrae and free air in the mediastinum, indicating esophageal perforation. Emergent surgery was performed. Intraoperatively, a longitudinal esophageal tear was identified. We stress the importance of being aware of the possibility of osteophyte-related esophageal perforation in patients with a history of a fall. A delayed diagnosis affects the prognosis.
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Perforación del Esófago , Mediastinitis , Osteofito , Heridas no Penetrantes , Perforación del Esófago/complicaciones , Perforación del Esófago/diagnóstico por imagen , Humanos , Masculino , Mediastinitis/complicaciones , Mediastinitis/diagnóstico por imagen , Persona de Mediana Edad , Osteofito/complicaciones , Osteofito/diagnóstico por imagen , Osteofito/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagenRESUMEN
ABSTRACT: Descending necrotizing mediastinitis is a serious complication of odontogenic infections. Incision and drainage of the maxillofacial infection with mediastinal drainage represent the principal management. However, chyle leakage after drainage in descending necrotizing mediastinitis is rare and has not been reported. Here the authors present a case of a 74-year-old man with chyle leakage after mediastinal drainage, which is successfully treated.
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Quilo , Mediastinitis , Herida Quirúrgica , Anciano , Drenaje/efectos adversos , Humanos , Masculino , Mediastinitis/diagnóstico por imagen , Mediastinitis/etiología , Mediastinitis/cirugía , Necrosis , Herida Quirúrgica/complicacionesRESUMEN
A 63-year-old man presented with hemoptysis and progressive dyspnea. His echocardiogram was concerning for pulmonary hypertension (PH) and CT chest showed fibrosing mediastinitis with possible cardiac involvement. Right heart catheterization revealed PH at rest and worsened with exercise. CT findings and simultaneous measurement of pulmonary capillary wedge pressure (PCWP), left atrial pressure, and left ventricular pressure helped diagnose pulmonary vein (PV) stenosis as the etiology of his PH. Both upper pulmonary veins were stented, and repeat exercise hemodynamic study revealed a substantial reduction in pulmonary arterial pressure with improvement in subjective dyspnea, cardiac output reserve, mechanical efficiency, and ventilatory efficiency. Repeat right upper PCWP normalized, consistent with resolution of the PV stenosis.
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Mediastinitis , Estenosis de Vena Pulmonar , Cateterismo Cardíaco , Hemodinámica , Humanos , Masculino , Mediastinitis/diagnóstico por imagen , Persona de Mediana Edad , Presión Esfenoidal Pulmonar , Esclerosis , Estenosis de Vena Pulmonar/diagnóstico por imagen , Estenosis de Vena Pulmonar/etiología , Resultado del TratamientoRESUMEN
Pulmonary extra-intestinal manifestations of inflammatory bowel disease are rare, comprising 0.21% to 0.4% of the inflammatory bowel disease population. Common symptoms include cough, chest pain, and dyspnea. Abnormal pulmonary function tests are common in these patients, with restrictive, obstructive, and diffusion capacity defects. CT scanning remains the most sensitive imaging technique to detect abnormalities. Pulmonary manifestations are diverse and include airway, parenchymal, and pleural disease. Large airway disease predominates, particularly bronchiectasis. Upper airway disease is rare but concerning for the development of acute airway compromise. To our knowledge, there are no reports of concurrent mediastinitis with tracheitis in the setting of inflammatory bowel disease. We present a case of a patient with ulcerative proctitis who experienced the development of inflammatory tracheitis and mediastinitis. Her disease responded to systemic steroids and biologic therapy. In addition to our case, we reviewed the literature and provide an approach to pulmonary complications as extra-intestinal manifestation of inflammatory bowel disease.
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Broncoscopía/métodos , Colitis Ulcerosa , Infliximab/administración & dosificación , Mediastinitis , Esteroides/administración & dosificación , Traqueítis , Adulto , Antirreumáticos/administración & dosificación , Biopsia/métodos , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/fisiopatología , Colitis Ulcerosa/terapia , Diagnóstico Diferencial , Vías de Administración de Medicamentos , Monitoreo de Drogas/métodos , Femenino , Humanos , Mediastinitis/diagnóstico por imagen , Mediastinitis/etiología , Mediastinitis/fisiopatología , Mediastinitis/terapia , Tomografía Computarizada por Rayos X/métodos , Tráquea/patología , Traqueítis/diagnóstico por imagen , Traqueítis/etiología , Traqueítis/fisiopatología , Traqueítis/terapia , Resultado del Tratamiento , Ultrasonografía Intervencional/métodosRESUMEN
Fibrous mediastinitis is a rare progressive disease characterized by invasive proliferation of fibrous tissue in the mediastinum. This tissue proliferation leads to compression of the mediastinal structures in the thoracic cavity, including the pulmonary vessels, esophagus, and trachea, causing corresponding symptoms and complications such as pulmonary hypertension. In clinical practice, the diagnosis of fibrous mediastinitis is often delayed or missed because of the rarity and variable clinical manifestations of this condition. This article presents a case of idiopathic fibrous mediastinitis that manifested as pleural effusion of unknown etiology along with a review of the relevant literature.
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Hipertensión Pulmonar , Mediastinitis , Derrame Pleural , Humanos , Mediastinitis/diagnóstico por imagen , Mediastino , Derrame Pleural/diagnóstico por imagenRESUMEN
The clinical data for a patient with pulmonary hypertension complicating mediastinal fibrosis secondary to tuberculosis admitted to the Second Xiangya Hospital, Central South University has been retrospectively analyzed, and the relevant literature has been reviewed. A 55-year-old Han Chinese woman initially presented with increasing shortness of breath on exertion for 7 months was admitted to our hospital in August 2013. Admission examination revealed an increased erythrocyte sedimentation rate, positive in T-SPOT TB test, multiform lesions in both lungs, the enlarged lymph nodes with calcification in mediastinum and bilateral hilar, the narrowed bilateral main bronchial lumen, and the thickened bilateral pleural, as well as adhesion band in the left pleural cavity under the thoracoscope. These results indicated that mycobacterium tuberculosis infection may be present. After 4 months of anti-tuberculosis treatment, there is no improvement in symptom of the patient. In 2016, the patient was admitted to our hospital again because of shortness of breath after exercise. The computed tomography pulmonary angiography revealed ill-defined soft tissue density lesions with calcification on bilateral hilar and mediastinum, encasing the major mediastinal vascular structures. The lesions compressed and wrapped the pulmonary artery and vein branches, resulting in their lumens narrowed severely. Moreover, the main pulmonary artery trunk was widened and the right ventricular was enlarged significantly. The patient was finally diagnosed as mediastinal fibrosis with the potential pathogenic mechanisms being tuberculosis, secondary pulmonary hypertension. Mediastinal fibrosis is an uncommon, benign and progressive condition characterized by an invasive proliferation of the fibrous tissue within the mediastinum, which can lead to pulmonary hypertension. Due to lack of specific clinical manifestations, diagnosis is difficult in the early stage. Physicians should pay attention to mediastinal fibrosis when accepting patients with unexplained pulmonary hypertension. Contrast-enhanced CT should be performed as early as possible to avoid mis-diagnosis or missed diagnosis.