BMJ Case Reports 2018; doi:10.1136/bcr-2017-221905
  • Images in…

Fibrosing mediastinitis-related pulmonary artery and vein stenosis-limiting chemotherapy

  1. Tochukwu M Okwuosa2
  1. 1Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
  2. 2Internal Medicine-Cardiology, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Michael Lawrenz Ferreras Co, michael_co{at}
  • Accepted 1 April 2018
  • Published 12 May 2018


A 74-year-old woman presented for second opinion of dyspnoea management. Her medical history included breast cancer treated with mastectomy, doxorubicin, cyclophosphamide and tamoxifen. She developed recurrent metastatic disease in the mediastinum, managed with 89 six-week cycles of paclitaxel over 10 years that was well tolerated and effective in stabilising the disease initially but eventually discontinued due to new sternal metastasis diagnosed on imaging and increasing dyspnoea. Examination revealed diminished left-sided breath sounds. Routine labs were normal. Echocardiogram showed normal left ventricular function and dilated right chambers. Repeat chest CT demonstrated: (1) extensive calcification …

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