Fibrozan Mediastinit Sonrası Pulmoner Vasküler Komplikasyonlar: En İyi Yaklaşım Nedir?

Abstract

Objectives:Fibrosing mediastinitis is a rare disorder caused by a diffuse fibrosis reaction in mediastinum, resulting in compression of the major mediastinal structures, especially vascular ones. This report presents an exceptional procedure to bypass the stenosed main pulmonary arteries.Case description:A 58-year old female patient presented with neck pain and dyspnoea 5 years ago. Computed tomography (CT) revealed a mass lesion expanding from mediastinum to the cervical region surrounding the major vascular structures. Biopsy interventions including 3 surgical biopsies confirmed the fibrosing mediastinitis. During the follow-up, the patient developed severe pulmonary hypertension (PAP: 90 mmHg). CT angiography showed severe stenoses of the bilateral main pulmonary arteries. To decrease pulmonary arterial pressure and improve the blood flow to lung, grafting from the pulmonary trunk to bilateral interlober pulmonary arteries under cardiopulmonary bypass was performed. In order to expose the interlobar pulmonary arteries and prevent kinking of the PTFE grafts (6 mm and 8 mm ringed), right middle lobectomy and lingulectomy were performed. The operation was completed successfully and the patient was discharged at postoperative day 10.Conclusions:An uncommon case of fibrosing mediastinitis causing compression of the pulmonary arteries, which was treated by means of an exceptional procedure, pulmonary artery bypass grafting, is reported herein. Pulmonary artery bypass grafting may be an option to treat the pulmonary hypertension caused by extensive fibrosis.Disclosure:No significant relationships.