Superior vena cava stenting in IgG4-associated mediastinal fibrosis
We report a rare case of IgG4-associated mediastinal fibrosis with complete superior vena cava (SVC) obstruction successfully managed by thrombolysis and stenting in a 33-year-old male. The patient presented with a mediastinal mass lesion with clinical findings of SVC obstruction. Surgical biopsy of...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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King Faisal Specialist Hospital and Research Centre
2020-03-01
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| Series: | Annals of Saudi Medicine |
| Online Access: | https://www.annsaudimed.net/doi/full/10.5144/0256-4947.2020.155 |
| _version_ | 1818084726938796032 |
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| author | Mohammed Khalid Ihab Weheba Abeer Abdelsayed Leena Mohammad Zeitouni Sarfraz Saleemi Eid Al Mutairy Syed Hassan |
| author_facet | Mohammed Khalid Ihab Weheba Abeer Abdelsayed Leena Mohammad Zeitouni Sarfraz Saleemi Eid Al Mutairy Syed Hassan |
| author_sort | Mohammed Khalid |
| collection | DOAJ |
| description | We report a rare case of IgG4-associated mediastinal fibrosis with complete superior vena cava (SVC) obstruction successfully managed by thrombolysis and stenting in a 33-year-old male. The patient presented with a mediastinal mass lesion with clinical findings of SVC obstruction. Surgical biopsy of the mediastinal mass lesion with histology and immunohistochemistry staining established the diagnosis of IgG4 associated mediastinal fibrosis. The patient was treated with a systemic steroid and rituximab, but despite treatment, SVC obstruction and thromboses persisted, surgical intervention was declined by the thoracic surgeon due to extensive mediastinal fibrosis and an expected poor outcome. Percutaneous SVC angioplasty, intravascular thrombolysis with tissue plasminogen activator and afterward stent placement was done by the interventional radiology service. This intervention is rare and possibly was lifesaving as it restored complete patency of the SVC. Our case is probably the first with IgG4 mediastinitis and SVC complete obstruction relieved by intravascular thrombolysis and SVC stent placement. It demonstrates that SVC stenting can relieve SVC obstruction in patients with a high risk of surgery either due to medical comorbidities or an expected high surgical risk like bleeding in the mediastinal fibrosis, which in our case of SVC obstruction was due to a nonoperable mediastinal tumor. SIMILAR CASES PUBLISHED: None to our knowledge. |
| first_indexed | 2024-12-10T19:58:29Z |
| format | Article |
| id | doaj.art-05a2f7984bd448ab8a8a407c2421a218 |
| institution | Directory Open Access Journal |
| issn | 0256-4947 0975-4466 |
| language | English |
| last_indexed | 2024-12-10T19:58:29Z |
| publishDate | 2020-03-01 |
| publisher | King Faisal Specialist Hospital and Research Centre |
| record_format | Article |
| series | Annals of Saudi Medicine |
| spelling | doaj.art-05a2f7984bd448ab8a8a407c2421a2182022-12-22T01:35:35ZengKing Faisal Specialist Hospital and Research CentreAnnals of Saudi Medicine0256-49470975-44662020-03-0140215515810.5144/0256-4947.2020.15510.5144_0256-4947.2020.155Superior vena cava stenting in IgG4-associated mediastinal fibrosisMohammed Khalid0Ihab Weheba1Abeer Abdelsayed2Leena Mohammad Zeitouni3Sarfraz Saleemi4Eid Al Mutairy5Syed Hassan6From the Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi ArabiaFrom the Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi ArabiaFrom the Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi ArabiaFrom the College of Medicine, King Saud University, Riyadh, Saudi ArabiaFrom the Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi ArabiaFrom the College of Medicine, King Saud University, Riyadh, Saudi ArabiaFrom the Department of Radiology, Johns Hopkins, Aramco Medical City, Saudi ArabiaWe report a rare case of IgG4-associated mediastinal fibrosis with complete superior vena cava (SVC) obstruction successfully managed by thrombolysis and stenting in a 33-year-old male. The patient presented with a mediastinal mass lesion with clinical findings of SVC obstruction. Surgical biopsy of the mediastinal mass lesion with histology and immunohistochemistry staining established the diagnosis of IgG4 associated mediastinal fibrosis. The patient was treated with a systemic steroid and rituximab, but despite treatment, SVC obstruction and thromboses persisted, surgical intervention was declined by the thoracic surgeon due to extensive mediastinal fibrosis and an expected poor outcome. Percutaneous SVC angioplasty, intravascular thrombolysis with tissue plasminogen activator and afterward stent placement was done by the interventional radiology service. This intervention is rare and possibly was lifesaving as it restored complete patency of the SVC. Our case is probably the first with IgG4 mediastinitis and SVC complete obstruction relieved by intravascular thrombolysis and SVC stent placement. It demonstrates that SVC stenting can relieve SVC obstruction in patients with a high risk of surgery either due to medical comorbidities or an expected high surgical risk like bleeding in the mediastinal fibrosis, which in our case of SVC obstruction was due to a nonoperable mediastinal tumor. SIMILAR CASES PUBLISHED: None to our knowledge.https://www.annsaudimed.net/doi/full/10.5144/0256-4947.2020.155 |
| spellingShingle | Mohammed Khalid Ihab Weheba Abeer Abdelsayed Leena Mohammad Zeitouni Sarfraz Saleemi Eid Al Mutairy Syed Hassan Superior vena cava stenting in IgG4-associated mediastinal fibrosis Annals of Saudi Medicine |
| title | Superior vena cava stenting in IgG4-associated mediastinal fibrosis |
| title_full | Superior vena cava stenting in IgG4-associated mediastinal fibrosis |
| title_fullStr | Superior vena cava stenting in IgG4-associated mediastinal fibrosis |
| title_full_unstemmed | Superior vena cava stenting in IgG4-associated mediastinal fibrosis |
| title_short | Superior vena cava stenting in IgG4-associated mediastinal fibrosis |
| title_sort | superior vena cava stenting in igg4 associated mediastinal fibrosis |
| url | https://www.annsaudimed.net/doi/full/10.5144/0256-4947.2020.155 |
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