CTICasesFibrosing Mediastinitis (Histoplasmosis-related Bronchial Stricture)
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Imaging findings
CT revealed abnormal soft tissue in the mediastinum causing attenuation of the superior segmental bronchus within the left lower lobe, leading to collapse and heterogeneous appearance of almost the entire left lower lobe. No endobronchial lesions were seen, but the proximal bronchi were significantly attenuated. Importantly, pulmonary veins and arterial branches were patent, and no significant calcifications were initially noted on imaging, which is atypical for classic fibrosing mediastinitis. PET scan showed hypermetabolic activity in the affected area. Pathology confirmed fibrosis and granulomas, consistent with chronic Histoplasmosis.
Key takeaways
Fibrosing mediastinitis, commonly associated with Histoplasmosis in endemic regions, can cause severe bronchial strictures and lobar collapse. While often presenting with calcifications and vascular involvement, it can rarely manifest primarily as bronchial obstruction without these classic features. Biopsy is often necessary to differentiate from neoplasm, with granulomas confirming the inflammatory nature, often related to prior fungal infection.
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