CTICasesFibrosing Mediastinitis Secondary to Histoplasmosis
Imaging findings
CT showed a dense, central soft tissue mass in the mediastinum with extensive calcification. This mass caused severe stenosis of the right interlobar pulmonary artery (which remained patent but irregular), decreased flow in the right inferior pulmonary vein, occlusion of the right superior pulmonary vein, and narrowing of the airways. The right lung exhibited small vessels, pleural effusion, thickening, and rounded atelectasis. Numerous mediastinal collaterals were present.
Key takeaways
Fibrosing mediastinitis, typically caused by histoplasmosis in endemic areas, presents as a central fibrosing and often calcified mass in the mediastinum. It can lead to severe obstruction of pulmonary arteries, veins, and airways, causing parenchymal abnormalities, effusions, and extensive collateral circulation. The pulmonary veins being wide open rules out fibrosing mediastinitis in a similar-appearing case without a central mass.
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