Surgical implications of sclerosing mediastinitis. A report of six cases and review of the literature.
Dunn EJ, Ulicny KS Jr, Wright CB, Gottesman L
Sclerosing mediastinitis is an uncommon disease associated with a multiplicity
of clinical syndromes. The cause of this disorder is probably an abnormal
fibroproliferative response to an inflammatory stimulus, most commonly
a granulomatous infection secondary to Histoplasma capsulatum. The pathophysiology
of this disease is predicated on the encasement of mediastinal vital organ
structures within a dense fibrotic mass. This mass appears to emanate from
an invasive chronic inflammatory process causing erosion as well as external
compression of these structures. The following case reports illustrate
the diversity of this disease entity, representing a patient population
from the Ohio River Valley, endemic for histoplasmosis. The purpose of
this report is to elucidate the various clinical manifestations of sclerosing
mediastinitis and to correlate the pathologic process with a rational approach
to treatment.
