Surgical Management of Fibrosing Mediastinitis Presenting as Superior Vena Cava Syndrome.

Fibrosing mediastinitis is a rare chronic inflammatory condition characterized by excessive fibrotic process in the mediastinum. Although various infectious processes are more common causes, it can also be related to several malignancies. We report a case of a 28-year-old woman with fibrosing mediastinitis related to an aggressive primary gray-zone lymphoma causing complete occlusion of the superior vena cava (SVC) and the innominate veins. She underwent several unsuccessful attempts at stenting and angioplasty. Due to worsening symptoms of SVC syndrome, she was ultimately treated with surgical reconstruction of the SVC and innominate veins using the Y-synthetic graft technique. A high degree of clinical suspicion should be maintained to diagnose fibrosing mediastinitis in onco-cardiovascular patients. With careful patient selection, review of techniques and imaging, surgical reconstruction may be a viable strategy for patients with SVC syndrome secondary to malignancy who have exhausted endovascular options.