CTICasesFibrosing Mediastinitis
Imaging findings
CT chest shows an infiltrative calcified soft tissue mass in the mediastinum causing severe narrowing of the pulmonary arteries and bronchi, associated with marked hypertrophy of the bronchial arteries acting as systemic-to-pulmonary collaterals.
Key takeaways
Fibrosing mediastinitis is a rare, benign, but clinically devastating fibroinflammatory process (most commonly triggered by histoplasmosis in the US). The dense fibrosis and calcification strangle mediastinal structures (SVC, pulmonary vessels, and airways). The body compensates for severe pulmonary artery narrowing by recruiting hypertrophied systemic bronchial arteries.
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