chronic mediastinitis
Introduction
Introduction to chronic mediastinal inflammation Chronic mediastinal inflammation, also known as idiopathic mediastinal fibrosis, is more complicated. Chronic mediastinal inflammation can lead to obstruction of the superior vena cava, and patients have a series of signs of symptoms of superior vena cava obstruction. Chronic mediastinal inflammation progresses slowly, forming a dense fibrous tissue in the mediastinum, which is flaky or lumpy. Occurs in the upper middle of the anterior mediastinum. Mainly invade the superior vena cava, innominate vein or azygous vein to cause stenosis or obstruction, other organs such as large pulmonary blood vessels or esophagus, trachea, bronchus can also be affected. A small number of patients can have both cervical fibrosis and retroperitoneal fibrosis. basic knowledge The proportion of illness: older male smokers are more common, the incidence rate is about 0.055--0.065 Susceptible people: no special people Mode of infection: non-infectious Complications: pulmonary hypertension
Cause
Causes of chronic mediastinum
(1) Causes of the disease
It is known that tuberculosis, tissue cytoplasmic bacteria, actinomycetes, sarcoidosis, syphilis, post-traumatic mediastinal hemorrhage and drug poisoning can cause mediastinal fibrosis, and may also be related to autoimmunity, and the etiology of some patients is unknown.
(two) pathogenesis
The disease progresses slowly, forming a dense fibrous tissue in the mediastinum, which is flaky or lumpy, which occurs in the upper middle part of the anterior mediastinum, mainly invading the superior vena cava, causing stenosis or obstruction due to innominate vein or azygous vein, other organs Such as large pulmonary vessels or esophagus, trachea, bronchus can also be affected, a small number of patients can have cervical fibrosis and retroperitoneal fibrosis.
Prevention
Chronic mediastinal inflammation prevention
1, mainly according to different diseases and therefore take different measures, such as antibiotics to control inflammation, hormones to promote absorption, diuretics to reduce edema, low molecular dextran to promote intravenous collateral circulation and other methods for treatment, to wait for the establishment of collateral circulation.
2, antibiotics to prevent infection, beware of dysbacteriosis.
3. According to the different primary diseases and causes of the patients, symptomatic supportive treatment is given.
4, strengthen exercise, enhance physical fitness, prevent recurrence.
Complication
Chronic mediastinal complications Complications pulmonary hypertension
The lesion involves the pulmonary artery, and the pulmonary artery can be compressed with pulmonary hypertension.
Symptom
Chronic mediastinal inflammation symptoms Common symptoms Difficulty, dizziness, dysphagia, mediastinal shadow, hepatic venous return disorder, upper limb edema, hemoptysis, hoarseness, jugular vein filling
The disease is usually asymptomatic in the early stage, but it can gradually appear symptoms of adhesion or compression of the mediastinum, mainly for superior vena cava syndrome, increased venous pressure, edema of the head and face, neck and upper limbs, jugular vein filling, upper side of the chest wall The circulatory vein dilates, the patient has headache, dizziness, difficulty in breathing, cyanosis and other symptoms. Due to the establishment of collateral circulation, the obstruction can generally be gradually reduced, the symptoms can be improved or disappeared, and the lesions involving other organs can cause obstruction of various organs. The corresponding symptoms, such as dysphagia, cough, shortness of breath, pulmonary artery pressure caused by pulmonary artery pressure, involving the pulmonary veins can lead to pulmonary vascular congestion, hemoptysis, occasional compression of the phrenic nerve caused by diaphragmatic paralysis, oppression of the recurrent laryngeal nerve hoarseness.
Examine
Chronic mediastinal examination
The erythrocyte sedimentation rate is normal.
X-ray examination can be found without abnormalities, but most patients have mediastinal pleural thickening or widening of upper mediastinum, calcified shadow in the lesion area, stomach, duodenal barium meal examination shows esophageal stricture, body slice shows trachea, bronchoconstriction Angiography is helpful in understanding the obstruction of the superior vena cava and its branches. CT examination also has diagnostic value.
Diagnosis
Diagnosis and diagnosis of chronic mediastinum
In addition to relying on clinical manifestations and imaging changes, mediastinal biopsy (open chest biopsy or mediastinal biopsy) is of great value.
The disease should be distinguished from the superior vena cava obstruction caused by the disease. The superior vena cava syndrome caused by this disease, the patient does not have fever, the erythrocyte sedimentation rate is normal, the disease is differentiated from central or mediastinal lung cancer, and malignant mediastinal tumor. It is difficult to be obvious when the tumor is obvious. It can be confused in the early stage, sometimes misdiagnosed as an allergic reaction, angioedema, right heart failure, and even angioedema.
