CTICasesFibrosing Mediastinitis with Pulmonary Artery Narrowing (likely Histoplasmosis-related)
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Imaging findings
Numerous calcified and non-calcified lymph nodes with conglomeration in the mediastinum, severely narrowing the proximal right main pulmonary artery. Pericardial thickening and a small effusion were also present. Lungs showed scattered granulomas but were otherwise unremarkable. Follow-up CT after antifungal treatment showed less soft tissue and more dystrophic calcification.
Key takeaways
Fibrosing mediastinitis, often related to Histoplasmosis, can cause severe narrowing of the pulmonary artery, leading to pulmonary hypertension. While cultures and antigen tests may be negative, empiric antifungal treatment can show improvement. Spleen calcifications are not always present with Histoplasmosis.
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