Application of Intravascular Ultrasound in Pulmonary Hypertension Caused by Fibrosing Mediastinitis - A Case Report

Background Fibrosing mediastinitis (FM) is a rare benign proliferative condition affecting the mediastinum. Pulmonary hypertension (PH) is a significant complication arising from the external compression of pulmonary arteries and/or veins by FM. In this report, we present a case of Pulmonary hypertension associated with fibrosing mediastinitis (PH-FM), in which intravascular ultrasound (IVUS) was used to image the vascular morphology of the lesion, guide balloon selection, and assess therapeutic efficacy. Case presentation The patient, an elderly woman experiencing palpitations and exertional dyspnea, was diagnosed with FM via echocardiography and chest computed tomography (CT), and precapillary PH was confirmed through right-heart catheterization (RHC). CT pulmonary angiography revealed stenosis of the pulmonary artery and vein, and pulmonary angiography revealed multiple segmental arterial ostial stenoses in both the left and right pulmonary arteries. We performed an endovascular intervention to address the significant occlusion of the pulmonary artery. Before the operation, IVUS was utilized to assess the degree of stenosis in the affected vessels and to guide balloon dilation selection. Postoperative IVUS was employed to evaluate the efficacy of the dilation. Following the intervention, the patient's exercise tolerance showed a marked improvement. Conclusions IVUS may be an appropriate method for the evaluating of pulmonary vascular mechanical properties in PH-FM.