CTICasesFibrosing Mediastinitis from Prior Histoplasmosis
Imaging findings
CT performed for pulmonary embolism evaluation shows hilar soft tissue thickening felt to exceed the usual amount of calcified lymph node seen incidentally as a normal Midwestern variant, with complete absence of the right inferior pulmonary vein and mild airway narrowing; there is also some contralateral lymphadenopathy that is denser and more likely reactive, related to aspiration, than the fibrotic nodes.
Key takeaways
This represents a variant of fibrosing mediastinitis, presumed related to remote histoplasmosis exposure, a characteristic Midwestern finding, and histologic confirmation of histoplasma is not required to make the diagnosis when the imaging pattern is characteristic. Attenuation differences can help distinguish denser fibrotic nodes from less dense reactive lymphadenopathy in the same patient.
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