Interventional treatment of refractory pleural effusion secondary to radiotherapy-induced fibrosing mediastinitis: A case report

Herein, we report a rare case of refractory pleural effusion secondary to radiotherapy-induced fibrosing mediastinitis. A male patient in his early 60s with a history of thoracic radiotherapy presented with a massive right-sided transudative pleural effusion. Imaging studies revealed occlusion of the right pulmonary vein and stenosis of the pulmonary artery, leading to a diagnosis of pleural effusion secondary to radiation-induced fibrosing mediastinitis. After unsuccessful pulmonary vein balloon dilation, an innovative approach was adopted: coil embolization of the pulmonary artery branches on the affected side. This strategy aimed to reduce visceral pleural hydrostatic pressure, thereby decreasing pleural fluid filtration. Postoperatively, the patient’s shortness of breath improved, and the rate of pleural fluid accumulation slowed, demonstrating favorable short-term efficacy. When pulmonary venous intervention is ineffective, this article provides a novel interventional strategy for managing fibrosing mediastinitis-associated refractory pleural effusion.