CTICasesFibrosing Mediastinitis (Histoplasmosis-related)
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Imaging findings
The radiograph from 2012 showed thickening of the right paratracheal stripe and convex margin, suggesting a mass or lymphadenopathy. A follow-up radiograph years later showed persistent opacity. A CT angiogram revealed calcified soft tissue areas where the right pulmonary artery should be, with only a little distal filling and hypertrophied bronchial arteries. There was very poor filling of the veins on the right, soft tissue mass, and a peritracheal calcified lesion corresponding to the radiograph. There was underperfusion of the right lung, thickening of bronchovascular bundles, diminutive lung size, and probably transplural collateral vessels. A VQ scan showed very little perfusion to the right lung, correlating with these findings.
Key takeaways
This constellation of findings is consistent with fibrosing mediastinitis related to histoplasmosis, presumably a remote infection that led to an immune response and development of this condition.
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