Dines D E, Payne W S, Bernatz P E, Pairolero P C
Chest. 1979 Mar;75(3):320-4. doi: 10.1378/chest.75.3.320.
Thirty-one patients with mediastinal granuloma and fibrosing mediastinitis were seen at the Mayo Clinic from 1975 through 1977. Review of this series reveals that surgery is necessary to establish a diagnosis if the lesions are noncalcified and indeterminate. Fibrosing mediastinitis most likely develops after rupture of the fibrocaseous material from mediastinal lymph nodes into the mediastinum. Thoracotomy, with evacuation of the granulomas, is recommended, especially when the lesions are large, in order to prevent subsequent fibrosing mediastinitis with involvement of the contiguous structures, such as the superior vena cava, azygos vein, trachea, esophagus, and left atrium. In most patients, obstruction of the superior vena cava develops slowly, and efficient collateral venous circulation occurs, allowing long-term survival and minimal disability.
1975年至1977年期间，梅奥诊所共接诊了31例纵隔肉芽肿和纤维性纵隔炎患者。回顾这一系列病例发现，如果病变未钙化且性质不明，就需要通过手术来明确诊断。纤维性纵隔炎很可能是在纤维干酪样物质从纵隔淋巴结破裂进入纵隔后发生的。建议进行开胸手术并清除肉芽肿，尤其是当病变较大时，以防止随后发生纤维性纵隔炎并累及相邻结构，如头臂静脉、奇静脉、气管、食管和左心房。在大多数患者中，头臂静脉阻塞发展缓慢，会形成有效的侧支静脉循环，从而实现长期生存且残疾程度最小。
