Abstract
A 10-year-old boy, previously in good health, experienced wheezing and exertional dyspnea. The symptoms had begun about 3 months before admission and progressed gradually to dyspnea at rest and orthopnea. On admission, the patient was in obvious respiratory distress with diffuse wheezing. There was no response to bronchodilators. Pulmonary function testing showed a fixed central airway obstruction, and chest x-ray showed mediastinal widening. Computed tomography (CT) demonstrated a mass displacing the esophagus and compressing the trachea. Surgical exploration revealed an inoperable mass surrounding the mediastinum. Histologic examination of the biopsy showed findings consistent with chronic fibrosing mediastinitis. No underlying disease process was identified. The patient was begun on steroid therapy and showed marked improvement. His pulmonary function tests and CT of the chest showed normal results after 2 months of therapy. He was gradually weaned off steroids and has been followed for 6 years, with no recurrence of disease. The etiology of chronic fibrosing mediastinitis and some points in the evaluation and treatment of this condition are discussed.
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