Pulmonary hypertension complicating mediastinal fibrosis secondary to tuberculosis: A case report and literature review.

Abstract

The clinical data for a patient with pulmonary hypertension complicating mediastinal fibrosis secondary to tuberculosis admitted to the Second Xiangya Hospital, Central South University has been retrospectively analyzed, and the relevant literature has been reviewed. A 55-year-old Han Chinese woman initially presented with increasing shortness of breath on exertion for 7 months was admitted to our hospital in August 2013. Admission examination revealed an increased erythrocyte sedimentation rate, positive in T-SPOT TB test, multiform lesions in both lungs, the enlarged lymph nodes with calcification in mediastinum and bilateral hilar, the narrowed bilateral main bronchial lumen, and the thickened bilateral pleural, as well as adhesion band in the left pleural cavity under the thoracoscope. These results indicated that mycobacterium tuberculosis infection may be present. After 4 months of anti-tuberculosis treatment, there is no improvement in symptom of the patient. In 2016, the patient was admitted to our hospital again because of shortness of breath after exercise. The computed tomography pulmonary angiography revealed ill-defined soft tissue density lesions with calcification on bilateral hilar and mediastinum, encasing the major mediastinal vascular structures. The lesions compressed and wrapped the pulmonary artery and vein branches, resulting in their lumens narrowed severely. Moreover, the main pulmonary artery trunk was widened and the right ventricular was enlarged significantly. The patient was finally diagnosed as mediastinal fibrosis with the potential pathogenic mechanisms being tuberculosis, secondary pulmonary hypertension. Mediastinal fibrosis is an uncommon, benign and progressive condition characterized by an invasive proliferation of the fibrous tissue within the mediastinum, which can lead to pulmonary hypertension. Due to lack of specific clinical manifestations, diagnosis is difficult in the early stage. Physicians should pay attention to mediastinal fibrosis when accepting patients with unexplained pulmonary hypertension. Contrast-enhanced CT should be performed as early as possible to avoid mis-diagnosis or missed diagnosis.