CTICasesSarcoid-Associated Fibrosing Mediastinitis
Imaging findings
A young patient with known sarcoidosis has confluent soft tissue interposing around the mediastinal vessels with some calcified nodes containing milk-of-calcium, but without the dense hard mass and complete vascular obliteration typical of histoplasmosis-related disease. Some vessels remain patent, with mild mass effect and a left upper lobe pulmonary artery narrowing, and dual-energy CT shows a corresponding perfusion defect. Transbronchial biopsy showed non-caseating granulomas, with perilymphatic nodules and peribronchial thickening.
Key takeaways
Sarcoidosis is a recognized but uncommon cause of fibrosing mediastinitis, producing confluent lymphoid soft tissue that more often causes venous stenosis with less mass effect than the rock-hard, vessel-obliterating fibrosing mediastinitis of histoplasmosis. Dual-energy CT can demonstrate the resulting perfusion defects, and such cases are sometimes referred as suspected chronic thromboembolic disease; response to corticosteroids or other immunosuppression is variable.
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