CTICasesFibrosing Mediastinitis with Pulmonary Vein Compression and Asymmetric Pulmonary Edema
Imaging findings
Chest CT and radiographs demonstrate extensive calcified paratracheal, mediastinal, and suprahylar lymphadenopathy and soft tissue thickening. There is severe narrowing and non-opacification of the right superior pulmonary vein. This obstruction results in highly asymmetric right upper lobe-predominant interstitial lung edema with prominent peri-bronchial fluid cuffing, septal lines, subpleural edema, and a unilateral right pleural effusion.
Key takeaways
Fibrosing mediastinitis is a slowly progressive, benign fibrotic process (frequently secondary to histoplasmosis) that can compress low-pressure mediastinal structures such as pulmonary veins. The resulting pulmonary venous obstruction leads to localized pulmonary venous hypertension and highly asymmetric, unilateral pulmonary edema that can be easily misdiagnosed as an infectious pneumonia or primary lung process.
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