CTICasesFibrosing Mediastinitis mimicking CTEPH
Imaging findings
CT chest shows calcified lymph nodes in the AP window and mediastinum, with dense, calcified infiltrative soft tissue causing complete occlusion of the left main pulmonary artery and left superior pulmonary vein, resulting in left lung volume loss, subpleural scarring, and prominent bronchial collateral arteries.
Key takeaways
Fibrosing mediastinitis is a rare, benign, but clinically severe process (most commonly triggered by Histoplasma capsulatum). The dense fibrosis can strangle and completely occlude central pulmonary arteries and veins, mimicking chronic thromboembolic disease (CTEPH) or congenital pulmonary artery absence. Surgical resection is high-risk due to the concrete-like consistency of the calcified mediastinal mass.
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