CTICasesGranulomatous Fibrosing Mediastinitis
Imaging findings
CT chest shows a calcified mediastinal and right hilar mass causing severe narrowing of the right pulmonary artery and right inferior pulmonary veins, associated with secondary bronchiectasis and bronchial wall thickening.
Key takeaways
Fibrosing mediastinitis is a rare complication of granulomatous infection (usually histoplasmosis in the US). It results in dense, calcified mediastinal fibrosis that constricts adjacent low-pressure pulmonary veins and arteries. The degree of metabolic activity on PET-CT varies and does not reliably indicate active inflammation, as chronic burn-out lesions can also show mild FDG avidity.
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