Liao J P, Hu Y, Qiu J X, Jin Z, Zhang H, Ma J, Wang G F
Deparment of Pulmonary and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2017 Mar 12;40(3):199-204. doi: 10.3760/cma.j.issn.1001-0939.2017.03.011.
To investigate the clinical characteristics and prognosis of mediastinal fibrosis. Twelve patients with mediastinal fibrosis diagnosed between 2008 and 2015 in our hospital were studied retrospectively. Clinical manifestations, radiological characteristics, endoscopic features, treatment and prognosis were analyzed. There were 3 males and 9 females, with a mean age of 68.8 years.Six patients had previous tuberculosis infection. The most common clinical symptoms were dyspnea on exertion (11 cases), cough (7 cases), and wheezing (6 cases). Chest CT scans revealed an infiltrative mediastinal process, with a discrete mass, enlargement of mediastinal lymph nodes, mediastinal lymph node calcification (9 case). Twelve patients had bronchial and pulmonary artery compression at lobar or segmental levels, 7 cases had localized pulmonary edema, and 6 cases had pulmonary atelectasis. The principal findings of bronchoscopy were distortion of bronchus with stenosis, multiple pigmentation of bronchial mucosa, and bronchial mucosal edema. Pulmonary hypertension (PH) was the main severe complication. One patients suffered from sudden death after bronchoscopy. Eleven patients were followed for 3 month to 7 years, and 5 patients got progression. Anti-tuberculosis therapy with or without corticosteroid was not beneficial. Tuberculosis was the leading cause of mediastinal fibrosis in our study, which was characterized with diffuse bronchial and pulmonary artery compression at lobar or segmental levels, and multiple pigmentation of bronchial mucosa.Anti-tuberculosis therapy with or without corticosteroids was not beneficial.
为研究纵隔纤维化的临床特征及预后。回顾性分析了2008年至2015年在我院诊断的12例纵隔纤维化患者。对其临床表现、影像学特征、内镜特征、治疗及预后进行了分析。其中男性3例,女性9例,平均年龄68.8岁。6例患者既往有结核感染史。最常见的临床症状为劳力性呼吸困难(11例)、咳嗽(7例)和喘息(6例)。胸部CT扫描显示纵隔有浸润性病变,伴有孤立性肿块、纵隔淋巴结肿大、纵隔淋巴结钙化(9例)。12例患者在叶或段水平有支气管和肺动脉受压,7例有局限性肺水肿,6例有肺不张。支气管镜检查的主要发现为支气管扭曲伴狭窄、支气管黏膜多处色素沉着及支气管黏膜水肿。肺动脉高压(PH)是主要的严重并发症。1例患者在支气管镜检查后猝死。11例患者随访3个月至7年,5例病情进展。抗结核治疗联合或不联合糖皮质激素均无益处。在我们的研究中,结核是纵隔纤维化的主要原因,其特征为叶或段水平的弥漫性支气管和肺动脉受压以及支气管黏膜多处色素沉着。抗结核治疗联合或不联合糖皮质激素均无益处。