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Abstract：
BACKGROUND: Pleural effusion caused by fibrosing mediastinitis is rarely reported. This study aimed to summarize the clinical manifestations, diagnosis and treatment of transudative pleural effusion due to fibrosing mediastinitis.
METHODS: Medical records and follow-up data of 7 patients with transudative pleural effusion due to fibrosing mediastinitis in Beijing Chaoyang Hospital between May 2014 and Feb 2018 were retrospectively analyzed.
RESULTS: These patients included 4 males and 3 females, with an average age of (64 ± 9) years. There were 3 left-sided effusions, 2 right-sided effusions and 2 bilateral effusions. Previous or latent tuberculosis was found in 6 patients. Pulmonary hypertension was indicated by echocardiography in all the 7 patients. Computed tomography pulmonary angiography (CTPA) of all the 7 cases showed increased soft tissue images visible in the mediastinum and bilateral hilus, different degrees of stenosis or occlusion in the pulmonary artery and pulmonary vein. In addition, 4 cases were found of right middle lobe atelectasis with a mediastinal window setting. There was interstitial pulmonary edema on the side of pleural effusion with a lung window setting. All the 7 patients were treated with intermittent drainage of pleural effusion combined with diuretic therapy. Five patients were treated with antituberculosis therapy. Up to now, two patients died of right heart failure and respiratory failure after 2 and 16 months respectively; The remaining 5 patients were still in follow up.
CONCLUSIONS: Fibrosing mediastinitis can lead to pulmonary vein stenosis or occlusion, and thus cause transudative pleural effusion, which can be detected by CTPA. Pulmonary hypertension, long time of cough, and a history of tuberculosis are common in these patients. The common therapy is intermittent drainage of pleural effusion combined with diuretic therapy.
METHODS: Medical records and follow-up data of 7 patients with transudative pleural effusion due to fibrosing mediastinitis in Beijing Chaoyang Hospital between May 2014 and Feb 2018 were retrospectively analyzed.
RESULTS: These patients included 4 males and 3 females, with an average age of (64 ± 9) years. There were 3 left-sided effusions, 2 right-sided effusions and 2 bilateral effusions. Previous or latent tuberculosis was found in 6 patients. Pulmonary hypertension was indicated by echocardiography in all the 7 patients. Computed tomography pulmonary angiography (CTPA) of all the 7 cases showed increased soft tissue images visible in the mediastinum and bilateral hilus, different degrees of stenosis or occlusion in the pulmonary artery and pulmonary vein. In addition, 4 cases were found of right middle lobe atelectasis with a mediastinal window setting. There was interstitial pulmonary edema on the side of pleural effusion with a lung window setting. All the 7 patients were treated with intermittent drainage of pleural effusion combined with diuretic therapy. Five patients were treated with antituberculosis therapy. Up to now, two patients died of right heart failure and respiratory failure after 2 and 16 months respectively; The remaining 5 patients were still in follow up.
CONCLUSIONS: Fibrosing mediastinitis can lead to pulmonary vein stenosis or occlusion, and thus cause transudative pleural effusion, which can be detected by CTPA. Pulmonary hypertension, long time of cough, and a history of tuberculosis are common in these patients. The common therapy is intermittent drainage of pleural effusion combined with diuretic therapy.
摘要：
背景：由纤维化纵隔炎引起的胸腔积液很少报道。本研究旨在总结其临床表现,纤维性纵隔炎致渗出性胸腔积液的诊断和治疗.
方法：回顾性分析北京朝阳医院2014年5月至2018年2月收治的7例纤维性纵隔炎所致渗出性胸腔积液患者的病历及随访资料。
结果：这些患者包括4名男性和3名女性，平均年龄(64±9)岁。有3例左侧积液,右侧积液2例，双侧积液2例。在6例患者中发现了先前或潜伏的结核病。7例患者超声心动图均显示肺动脉高压。所有7例患者的CT肺动脉造影（CTPA）均显示在纵隔和双侧肺门可见的软组织图像增加，肺动脉和肺静脉不同程度的狭窄或闭塞。此外,4例发现右中叶肺不张，纵隔窗设置。胸腔积液侧有间质性肺水肿，肺窗设置。7例患者均采用胸腔积液间歇引流联合利尿剂治疗。5例患者接受了抗结核治疗。到目前为止,2例患者分别于2个月和16个月后死于右心衰竭和呼吸衰竭；其余5例患者仍在随访中。
结论：纤维性纵隔炎可导致肺静脉狭窄或闭塞，从而引起渗出性胸腔积液,可以通过CTPA检测到。肺动脉高压,长时间的咳嗽，结核病史在这些患者中很常见。常用的治疗方法是胸腔积液间歇引流联合利尿剂治疗。
方法：回顾性分析北京朝阳医院2014年5月至2018年2月收治的7例纤维性纵隔炎所致渗出性胸腔积液患者的病历及随访资料。
结果：这些患者包括4名男性和3名女性，平均年龄(64±9)岁。有3例左侧积液,右侧积液2例，双侧积液2例。在6例患者中发现了先前或潜伏的结核病。7例患者超声心动图均显示肺动脉高压。所有7例患者的CT肺动脉造影（CTPA）均显示在纵隔和双侧肺门可见的软组织图像增加，肺动脉和肺静脉不同程度的狭窄或闭塞。此外,4例发现右中叶肺不张，纵隔窗设置。胸腔积液侧有间质性肺水肿，肺窗设置。7例患者均采用胸腔积液间歇引流联合利尿剂治疗。5例患者接受了抗结核治疗。到目前为止,2例患者分别于2个月和16个月后死于右心衰竭和呼吸衰竭；其余5例患者仍在随访中。
结论：纤维性纵隔炎可导致肺静脉狭窄或闭塞，从而引起渗出性胸腔积液,可以通过CTPA检测到。肺动脉高压,长时间的咳嗽，结核病史在这些患者中很常见。常用的治疗方法是胸腔积液间歇引流联合利尿剂治疗。
