Fibrosing mediastinitis: An unusual cause of superior vena cava symptoms

Fibrosing mediastinitis is a rare benign disorder caused by the proliferation of acellular collagen and fibrous tissue within the mediastinum. Although many cases are idiopathic, many (and perhaps most) cases are thought to be caused by an abnormal immunologic response to Mycobacterium tuberculosis and Histoplasma capsulatum infections. Collagen formation leads to compression of vital structures, resulting in cough, chest pain, and dyspnea. The following case is a former healthy middle-age man who presented with an 8-year history of cough, chest pain, facial swelling, and trouble breathing, and was subsequently found to have fibrosing mediastinitis. Fibrosing mediastinitis should be considered in the differential diagnosis of cough, chest pain, and dyspnea, primarily when findings such as increased venous pressure are present on physical exam, and hilar abnormalities are seen on chest radiograph.