Idiopathic Fibrosing Mediastinitis Causing Extensive Fibrotic Veno-occlusion with Minimal Mediastinal Involvement / 결핵

A 68-year-old woman was admitted after suffering facial edema with neck vein engorgement ofr approximately 2 months. A chest X-ray showed a mild widening of the superior mediastinum and a luminal obliteration of the super ior vena cava (SVC) was noted on a computed tomograph. Venography showed that both subclavian veins were obstructed at the level of the poxima clavicle with a nonvisualization of the SVC. The SVC, both the innominate and the left inthrnal jugular veins were completely obstructed with extensive cord-like fibrotix changes despite the obsence of mediastinal involvement. The microscopic features showed a chronic granulomatous inflammation with a fibrosis minimally invading the mediastinal fat, which is cosistent with fibrosing mediastinitis.

A Case of Superior Vena Cava Syndrome Caused by Klebsiella Pneumonia / 결핵

Superior vents lava(SVC) syndrome is mostly related to a malignant process, but many different benign causes haute also been described. We report a case of SVC syndrome caused by Klebsiella pneumonia diagnosed by sputum culture and serial chest X-ray changes. A 27-year-old man had been in stable health until three days before admission, when he complained of pleuritic chest pain, facial flushing, and shortness of breath. Examination of the head and neck disclosed edema of face and both arms, and jugular venous distention to the angle of the jaw. The chest auscultation resealed decreased breath sound without crackle on right upper lung field. The chest roentgenogram showed homogenous air space consolidation on right upper lobe, asociated with downward displacement of minor fissure and contralateral displacement of trachea, but air bronchogram was not seen. We began antibiotic therapy under impression of pneumonia after assailable culture was taken from blood and sputum. SVC scintigraphy showed stasis of drain of right brachiocephalic vein at the proximal portion with reflux into the right internal jugular vein and faintly visible SVC via the collaterals. Sputum culture resealed Klebsiella pneumoniae. Antibiotic therapy resulted in a cure of infection and disappearance of facial swelling. Follow-up SVC scintigraphy after 20 days showed normal finding. We first report a case of SVC syndrome caused by klebsiella pneumonia