CTICasesFibrosing Mediastinitis secondary to Histoplasmosis
Imaging findings
Chest CT demonstrates an infiltrative, calcified right hilar mass that causes complete occlusion of the right inferior pulmonary vein, severe narrowing of the right superior pulmonary vein, and compression of the right main pulmonary artery. This has resulted in right lung volume loss, marked hypertrophy of the extrapleural fat, and calcified pleural thickening. Background calcified granulomas in the spleen confirm remote histoplasmosis.
Key takeaways
Fibrosing mediastinitis is a rare, benign, but clinically aggressive fibrotic process triggered by Histoplasma capsulatum. It causes progressive compression of low-pressure mediastinal vessels, particularly the pulmonary veins and SVC. The resulting venous occlusion leads to chronic venous congestion and localized pulmonary edema. Chronic cases demonstrate marked volume loss, calcification, and extrapleural fat hypertrophy.
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