Vascular sequelae of mediastinal fibrosis.

Fibrosing mediastinitis is a condition in which mediastinal fat is replaced by fibrous tissue. Complications may arise due to progressive fibrotic infiltration and compression of major vascular, respiratory, and nervous structures within the mediastinum. We describe 3 similar cases of fibrosing mediastinitis with pulmonary vessel involvement. Imaging and intraoperative observation revealed involvement of the pulmonary vasculature in all 3 patients. Perfusion studies showed decreased or absent perfusion to one or both of the lungs. All patients tested negative for histoplasmosis, 2 required lung resection, with the 3rd forgoing surgery.