Key Points

• Chronic mediastinitis is most commonly associated with fungal or mycobacterial infections and encompasses a spectrum of inflammation from a chronic granulomatous process to dense fibrosis.
• The inflammatory process can cause focal or diffuse encroachment or occlusion of mediastinal structures.
• Symptoms of chronic mediastinitis are secondary to the compromised structure(s).
• Medical therapy with antifungal therapy or anti-inflammatory agents such as steroids have been reported to have variable beneficial therapeutic effects in reversing or resolving the inflammatory process.
• Surgery often plays a role in establishing a diagnosis, as distinguishing the benign chronic mediastinitis process from a neoplastic or malignant process by clinical and radiographic features alone can be difficult.
• Both surgical and endovascular therapies can be required to palliate symptoms due to significantly compressed organs.
• Therapy with the anti B-lymphocyte agent rituximab has also shown promise in terms of clinical and radiographic responses and can be discussed in a multi-disciplinary setting for symptomatic patients as an adjunct or alternative to an invasive procedure.