CTICasesFibrosing Mediastinitis with Extensive Venous Collaterals
Imaging findings
CT chest shows a calcified mediastinal mass encasing and occluding the superior vena cava. Massively dilated venous collaterals are present, including a giant superior costal vein, paraspinal venous plexus, and a hot quadrate sign in the liver from collateral flow.
Key takeaways
Fibrosing mediastinitis is a late, abnormal immunologic reaction to histoplasmosis that causes progressive encasement of mediastinal vessels. SVC obstruction recruits extensive collateral networks (superior costal vein, azygos system, spinal plexus), resulting in systemic-to-portal shunts.
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