Pulmonary venous and arterial hypertension due to chronic fibrous mediastinitis. Hemodynamics and pulmonary function.

ALTHOUGH chronic fibrous mediastinitis is responsible for 8 to 23% of the cases of superior vena caval obstruction,1-7 it may also compress or obstruct other mediastinal structures. Involvement of the tracheobron-chial tree" 8, 9pulmonary artery,10-12 esophagus ," 9, 13 aorta, and coronary arteries14 has been reported. Obstruction of pulmonary veins, however, is uncommon and may not be recognized as a cause of pulmonary hyperten-sion.", 15-17 This report describes the clinical findings, the abnormal hemodynamic and ventilatory functions, and pathological material in a case of complete or partial obstruction of the superior vena cava, the bronchial tree, and pulmonary veins with associated pulmonary hypertension and diffuse interstitial fibrosis. Repeated observations, including hemodynam-ic and pulmonary function studies, were made over a 3-year period. The presumptive diagnosis of pulmonary vein obstruction secondary to chronic fibrous mediastinitis was confirmed by thoracotomy following which the patient's condition has remained stable for 10 months.sin.