The obstetric anesthetic management of fibrosing mediastinitis: a case series and review of the literature (1990-2025).

BACKGROUND

Fibrosing mediastinitis is a rare and potentially deadly disease characterized by immune mediated fibrosis. In the United States, it most commonly arises as a post-infectious sequela of Histoplasma capsulatum infection, leading to progressive mediastinal compression that can complicate pregnancy. This case series seeks to provide guidance on the anesthetic considerations and management of patients with fibrosing mediastinitis in the peripartum period.

METHODS

We conducted a retrospective review to identify patients with fibrosing mediastinitis who received pregnancy care at Mayo Clinic Rochester since January 1, 1990.

RESULTS

Seven pregnancies were recorded in five patients with fibrosing mediastinitis. Three patients had pulmonary hypertension, three had superior vena cava syndrome, and three had pulmonary vein stenosis. All patients received neuraxial anesthesia or analgesia; three delivered at term; two cases delivered vaginally, three cases by cesarean delivery, one case delivered by cesarean followed by a hysterectomy, and one underwent surgical termination. Two patients with severe PH underwent surgical intervention in the cardiac surgery operating room, with one patient having femoral sheaths placed for extracorporeal membrane oxygenator support on standby. In six of the seven cases, we observed no major maternal morbidity, mortality, or anesthetic complications. One patient with severe pulmonary hypertension experienced postpartum hypoxia resulting in a prolonged hospital stay.

CONCLUSIONS

Our findings highlight that fibrosing mediastinitis severity is variable and depends on the presence of long-term sequelae of mediastinal obstruction, specifically the development of pulmonary hypertension. This single center's experience suggests that pregnant patients with fibrosing mediastinitis can have favorable outcomes with coordinated multidisciplinary care.