CTICasesFibrosing Mediastinitis mimicking Chronic Pulmonary Thromboembolism
Imaging findings
Frontal chest radiograph reveals a small right lung. CT of the chest demonstrates dense calcification and soft tissue thickening within the right hilum, causing severe extrinsic narrowing and compression of the right main pulmonary artery and main bronchus, mimicking chronic thromboembolic disease. Downstream mosaic lung perfusion and bronchiectasis are also present.
Key takeaways
Fibrosing mediastinitis is a rare, invasive fibrotic process (often a late immunological response to histoplasmosis) that can mimic CTEPH or primary pulmonary neoplasm by causing severe extrinsic compression and calcific narrowing of the central pulmonary arteries, veins, and airways. Careful evaluation of the mediastinal soft tissues and the pattern of calcification helps distinguish extrinsic compression from intrinsic thromboembolic disease.
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