Fibrosing mediastinitis (FM), which is also known as mediastinal fibrosis or sclerosing mediastinitis, is an uncommon, benign and progressive condition. What is Fibrosing Mediastinitis? Medistinal fibrosis is the common, but most severe, late complication of Histoplasmosis. Many Physicians believe mediastinal. Idiopathic Fibrosing Mediastinitis. Questions posed and edited by Candace McIntosh and Lucille Enix Reponses by James Loyd, M.D.. What are the symptoms.

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Are Serevent and Flovent inhalers helpful to patients? Because there are so meriastinitis patients with Idiopathic FM, reliable information about response to treatment is scarce.

Fibrosing Mediastinitis – NORD (National Organization for Rare Disorders)

Mediastinal granuloma affects the mediastinal lymph nodes and causes substantial enlargement of the lymph nodes. Is there a relationship between thyroid deficiency and Idiopathic FM? Is the circulatory system affected and, if so, in what ways? Rarely calcified stones broncholith may work their way into airways, and may be coughed out, or they may cause bronchial obstruction and infection.

Histoplasmosis has also been found in urban settings and is occasionally referred to as an urban disease as well. Because the Idiopathic ribrosing is far less common, there is far less information about the risk of death from it.

Each of the imaging modalities used clinically has unique advantages and disadvantages. In Idiopathic FM cough may be related to the direct compression on the airways, or to fluid accumulation in the lung caused by compression of vessels. Alone we are rare. Idiopathic fibrosing mediastinitis is not related to histoplasmosis.

Fibrosing Mediastinitis | FAQ

In the modern era, radiation is rarely used for any condition other than cancer. The number of persons with the severe complication, fibrosing mediastinitis, is a small fraction, estimated to total only a few hundred in the US, of the millions of individuals infected by histoplasmosis. The surgical removal was associated with rapid regrowth of new fibrotic tissue back to its former extent within just a few months of its removal. There are no proven causes of Idiopathic FM.

Are chemotherapy and radiation ever used and, if so, under what circumstances?


Rare Disease Database

Subdivisions of Fibrosing Mediastinitis fibrosing mediastinitis as a late complication of histoplasmosis idiopathic fibrosing mediastinitis. Viruses, exposure to radiation and environmental hazards, time spent in wooded and forested area. All drugs have complications in some patients.

When structures of both lungs are affected, this can be serious and life threatening, so catheterization with stenting Albers meduastinitis restore flow in some vessels may benefit many patients.

Post histoplasmosis fibrosing mediastinitis is characterized by invasive, calcified fibrosis centered at locations of lymph nodes, which, by definition, occludes major vessels or airways. Obviously it must have progressed at an earlier time to have caused the obstruction of vessels or airways, but the time course is unknown. The epidemic was short-lived and influenza-like.

Antifungal therapies are not shown to change the course for FM, which is more related to ongoing reaction of the immune system, rather than growth of organisms. Many physicians believe fibrosing mediastinitis to be the result of an abnormal immunologic response to antigens released by the soil-based fungus histoplasma capsulatum. The natural history of Idiopathic FM is not known, but there are reports of individual patients who had a pharmacologic response or spontaneous improvement, which has not been seen with post Histoplasmosis FM.

Have these treatments been used successfully?

…a little information goes a long way

The University of Texas Southwest Medical Center reported between and cases of Histoplasma infection during a year period when buildings were under construction. When FM patients cough mmediastinitis, catheterization of the aorta to perform bronchial artery embolization is effective to block the arteries that are the source of bleeding in most patients.

What is HLA-A2 antigen? CT scan is the best modality to show calcification, to help distinguish the post Histoplasmosis form of FM which usually has calcification, from the Idiopathic proliferative form of FM which is usually not calcified.

Idiopathic FM seems to be a persistent disease in most patients, even with treatment, but it varies greatly between different patients.

Pulmonary venous obstruction usually presents with shortness of breath and coughing blood hemoptysis. Sometimes surgical biopsy of the abnormal tissue in the mediastinum is needed to exclude malignancy such as a lymphoma, especially if the CT scan shows that the tissue does not have calcification, which is a hallmark sign of FM which complicates prior histoplasmosis. Histoplasmosis in Normal Hosts. Mediastinal granuloma can also be caused by mycobacteria, so tuberculosis testing should be performed in patients at risk for it.


Some reports describe responses of individual patients to prednisone or tamoxifen, but we need better information about the magnitude of response, its duration, and for what percent of patients.

In addition, it can occur in association with other idiopathic fibroinflammatory disorders at sites outside the chest, including retroperitoneal fibrosis, sclerosing cholangitis, Riedel thyroiditis, pseudotumor of the orbit, and others. Percutaneous vascular stent implantation as treatment for central vascular obstruction due to fibrosing mediastinitis. Some infected persons may suffer flu-like symptoms.

Often symptoms of fibrosing mediastinitis do not develop until the disease has progressed to a level at which there is damage to some vessel or organ, usually due to insufficient blood flow because of an obstructed vessel.

HLA are Human Leukocyte Antigens, which are on the surface of nearly every human cell and are important in immune recognition and other functions. And, is it known whether the various drug treatments can cause the fibrosis to go into remission, or just arrest the fibrosis?

Overall, histoplasmosis is considered usually to be an asymptomatic and clinically insignificant infection. N Engl J Med. Epub Sep If the scar tissue in FM is localized, surgical resection has been used rarely, but is high risk and appropriate for very few patients. Itraconazole is an oral antifungal treatment which is often used for patients who have fibrosing mediastinitis due to histoplasma, but there is no evidence it helps.

Corticosteroids such as prednisone appear to provide benefit for some patients, but can also cause serious side effects. It is not known why some individuals are predisposed to excessive immune response to the organism, which leads to excessive scarring and obstruction of major vessels or airways that characterizes FM. Typically, people with fibrosing mediastinitis were originally infected with H. Do you consider Idiopathic Fibrosing Mediastinitis an autoimmune disease?