Fibrosing Mediastinitis in Pregnancy

BACKGROUND: Fibrosing mediastinitis (FM) is a rare, progressive disorder characterized by dense fibrotic encasement of mediastinal structures, leading to airway and vascular compromise. Pregnancy-associated FM is exceptionally uncommon, with fewer than 2 dozen cases reported. CASE SUMMARY: We present a case of a 37-year-old woman, gravida 1 para 0, with known FM who developed antepartum hemoptysis and left lung atelectasis at 23 weeks of pregnancy. Computed tomography scan of the chest showed an 80% narrowing of the left main bronchus due to a calcified mediastinal mass. She was managed conservatively with nebulizers and physiotherapy, followed by bronchoscopy with balloon dilation of the left main bronchus. Delivery via classical cesarean at 24 weeks resulted in a viable neonate. DISCUSSION: Physiologic changes during pregnancy can exacerbate cardiopulmonary compromise in FM, requiring multidisciplinary co-ordination. TAKE-HOME MESSAGES: FM may remain stable during pregnancy, and conservative management with close pulmonary and obstetric collaboration can achieve favorable outcomes. Further evaluation with a computed tomography chest scan may be required to assess the need for intervention when oxygenation and hemodynamic status are compromised.