CTICasesFibrosing Hilatis Secondary to Histoplasmosis
Imaging findings
CT showed pleural effusion, large bronchial arteries, and numerous chest wall collaterals. In the inferior left hilum, a calcified soft tissue mass surrounded the left lower lobe pulmonary artery, causing it to taper. Narrowing of the left lower lobe pulmonary vein and airways was also noted. Septal lines and thickening indicated venous and lymphatic obstruction. Subcarinal and right hilar lymphadenopathy were present. A transpleural collateral blush from an intercostal artery into the lung was also visualized.
Key takeaways
Fibrosing hilatis is a localized form of fibrosing mediastinitis, typically due to histoplasmosis, where the fibrotic process is primarily confined to the hilar region. It presents with a calcified hilar mass, obstruction of hilar vessels and airways, pleural effusion due to venous/lymphatic obstruction, and prominent collateral circulation. Histoplasmosis more commonly causes hilar lymph node involvement than mediastinal.
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