• Journal of Chest Surgery
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• v.34 no.11
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• pp.883-886
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• 2001

Mediastinal fibrosis is uncommon but may result in entrapment and erosion of vital mediastinal structures by fibrous tissues. Idiopathic mediastinal fibrosis involved esophagus is very rare, and only a few cases have ever been reported. Such idiopathic mediastinal fibrosis involved esophagus is an enigmatic inflammatory fibrous tissue proliferation, but the treatment has not yet been clearly defined. We had successfully treated in such a case with partial esophagolysis and esophagomyotomy.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.373-378
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• 2001

An idiopathic mediastinal fibrosis is a rare disease with an unknown etiology. It is a benign condition in which a fibrosis of the soft tissue and chronic inflammation occurs within the mediastinum. This leads to a constriction and obliteration of the adjacent mediastinal structures, particularly the great veins. This can result in a variety of clinical conditions depending on the anatomic location of the disease. Here, we report a case of an idiopathic mediastinal fibrosis with vocal cord palsy, which was confirmed by a biopsy with a thoracotomy. Postoperative medical treatment using prednisolone and tranilast was performed.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.935-941
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• 1997

Mediastinal fibrosis is pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. Mediastinal fibrosis is local expression of a family of systemic fibrosing syndroms. This can result in compression of adjacent mediastinal structures. Idiopathic fibrosing syndromes include retroperitoneal fibrosis, sclerosing cholangitis of the orbit and fibrosis of the thyroid gland(Riedel's struma). The cause of these disorders is obscure, in some instance there is an underlying malignancy, infection, history of drug ingestion, or trauma with retroperitoneal bleeding. Treatment of mediastinal fibrosis depends on structures involved by the fibrotic process. The disease is self limited in most case or improved by steroids uses. We experienced a case of idopathic sclerosing mediastinitis with orbital fibrous dysplasia of unknowm cause, which was confirmed by open lung biopsy, so reported it with a review of literature.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.113-117
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• 2003

Idiopathic mediastinal fibrosis is very rare. We report two cases of a 41-year-old man and 65-year-old man who presented with backache and vocal cord palsy, subsequently confirmed to be idiopathic mediastinal fibrosis. Preoperative chest computed tomography showed a mediastinal mass and thoracoscopic biopsy was preformed. The mass was hard, dense and partially calcified, and adhered the adjacent mediastinal structure. Postoperative medical treatment was not performed, and during 5 and 7 month follow-up has not demonstrated any complication.

• Journal of Chest Surgery
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• v.12 no.2
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• pp.140-144
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• 1979

This is a report of a case of superior vena caval syndrome due to idiopathic mediastinal fibrosis, which was surgically treated. The patient was 35-year-old Korean male who progressively complained shortness of breath about for 40 days prior to operation. Phlebogram of SVC showed indentation of SVC at the site of cavoatrial junction. The operation was performed under impression of bronchogenic cancer of right hilum. After thoracotomy, it was found a irregular mass in the mediastinum at the level of cavoatrial junction, which was developed to surrounding with SVC, pericardium, trachea and bronchus and they fixed together to immobile. Bypass graft between SVC and right atrial appendage was performed using a pericardial roll tube This is a report of a case of superior vena caval syndrome due to idiopathic mediastinal fibrosis, which was surgically treated. The patient was 35-year-old Korean male who progressively complained shortness of breath about for 40 days prior to operation. Phlebogram of SVC showed indentation of SVC at the site of cavoatrial junction. The operation was performed under impression of bronchogenic cancer of right hilum. After thoracotomy, it was found a irregular mass in the mediastinum at the level of cavoatrial junction, which was developed to surrounding with SVC, pericardium, trachea and bronchus and they fixed together to immobile. Bypass graft between SVC and right atrial appendage was performed using a pericardial roll tube [$1.3{\times}5$ cm]. After that SVC was decompressed very well. SVC pressure was markedly reduced from 32 cm $H_2O$ in preoperative to 21 cm $H_2O$in postoperative. Mediastinal fibrosis was confirmed by histopathological examination postoperatively. The postoperative course was uneventful.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.107-114
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• 1990

During a ten-year period from August, 1978 to September, 1989 45 patients with benign esophageal stricture were surgically evaluated. The results are as follows; l. Out of 45 patients, there were 26 males and 19 females ranging from 2 to 70 years of age with a mean of 31.9 years. 2. The most common cause of benign esophageal stricture was corrosive burn due to caustic agents[40 cases, 88.9 %]. Corrosive agents were 15 cases of lye, 22 cases of acid and 3 cases of other agents. Other causes were two cases of esophageal web and each one case of previous surgical result, inflammation and idiopathic mediastinal fibrosis respectively. 3. The most frequent stricture site was whole esophagus as 21 cases[46.7 %] and the next was lower a third thoracic esophagus[10 cases, 25.0%]. 4. In 33 of total 45 cases, colon interposition with right colon was performed without resection of the strictured esophagus except one case which was complicated esophageal cancer. Other procedures were 4 cases esophagogastrostomy with segmental resection, 2 cases of plastic repair and so on. 5. Major postoperative complications which were needed for secondary operation were 5 cases[11.1 %]. [2 cases of stenosis, ileus and ulcer bleeding respectively] Overall mortality rate was 4.4 %.

• Tuberculosis and Respiratory Diseases
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• v.52 no.3
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• pp.278-282
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• 2002

A 68-year-old woman was admitted after suffering facial edema with neck vein engorgement for approximately 2 months. A chest X-ray showed a mild widening of the superior mediastinum and a luminal obliteration of the superior vena cava(SVC) was noted on a computed tomograph. Venography showed that both subclavian veins were obstructed at the level of the proximal clavicle with a nonvisualization of the SVC. The SVC, both the innominate and the left internal jugular veins were completely obstructed with extensive cord-like fibrotic changes despite the absence of mediastinal involvement. The microscopic features showed a chronic granulomatous inflammation with a fibrosis minimally invading the mediastinal fat, which is consistent with fibrosing mediastinitis.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.732-738
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• 1999

Background: Video-assisted thoracoscopic surgery has become a standard therapy for several diseases such as pneumothorax, hyperhidrosis, mediastinal mass, and so on. These methods usually required single-lung ventilation with double-lumen endobronchial tube to collapse the lung under general anesthesia. However, risks of general anesthesia itself and single-lung ventilation must be considered in high-risk patients. Material and method: Between December 1997 and July 1998, eight high-risk patients (6: empyema, 1: intractable pleural effusion, 1: idiopathic pulmonary fibrosis) with underlying pulmonary disease and poor general condition were treated by video-assisted thoracoscopic surgerys under epidural anesthesia and spontaneous breathing. Result: Video-assisted thoracoscopic surgerys were successfully per formed in 7 patients. Conversion to general anesthesia was required in 1 patient because of decrease in spontaneous breathing. But, conversion to open decortication was not required. In two patients with chronic empyema, one patient required thoracoplasty as a second procedure and one patient required re-video-assisted thoracoscopic procedure due to a recurrence. The mean operative time was 31.8$\pm$15.2 minutes. No significant postoperative respiratory com plication was encountered. Conclusion: Video-assisted thoracoscopic surgerys can be per formed safely under epidural anesthesia for the treatment of empyema and diagnosis of pulmonary abnormalities in high-risk patients.