Fibrosing Mediastinitis With Complex Airway Obstruction: A Combination of Fixed Obstruction, Dynamic Collapse, and Vascular-Esophageal Involvement.

Fibrosing mediastinitis is a rare fibroinflammatory condition characterized by progressive fibrous infiltration of the mediastinum that can compromise bronchovascular, esophageal, and vascular structures. Its clinical presentation is heterogeneous and can mimic more prevalent respiratory diseases, such as bronchial asthma, leading to significant diagnostic delays. This case reports a patient with fibrosing mediastinitis whose presentation was suggestive of bronchial asthma. This patient developed a set of findings that revealed a triple mechanism of airway obstruction: fixed obstruction, dynamic collapse, and vascular-esophageal involvement. Treatment with continuous positive airway pressure (CPAP) produced significant and sustained clinical improvement, even after bronchodilators were withdrawn. This case highlights the importance of considering fibrosing mediastinitis in patients with refractory respiratory symptoms and underscores the role of CPAP as a symptomatic therapeutic option in selected cases.