CTICasesFibrosing Mediastinitis from Histoplasmosis with Cor Pulmonale
Imaging findings
CT in a 35-year-old demonstrates dense soft tissue encasing the right hilum and mediastinum with associated calcifications, consistent with fibrosing mediastinitis from prior histoplasmosis. The fibrous tissue narrows the right pulmonary artery and its branches, occludes the right pulmonary veins and superior vein, and narrows the left pulmonary artery and airway. The left atrium is markedly small from pulmonary venous obstruction. Mosaic attenuation is extensive on the left with asymmetric distribution. The right heart is dilated and hypertrophied from severe pulmonary hypertension with a bowing interventricular septum. Splenic punctate calcifications support prior histoplasma exposure.
Key takeaways
Fibrosing mediastinitis from histoplasmosis can produce progressive occlusion of pulmonary vasculature (arteries and veins) and airways, leading to severe secondary pulmonary hypertension and cor pulmonale. The order of vessel involvement is typically pulmonary veins first, then arteries, then airways. Once all central vessels are occluded there is no surgical or interventional option, and the disease is uniformly fatal. Calcifications in the mediastinal fibrous tissue are a helpful clue to histoplasmosis as the underlying cause. Patients from endemic regions of the Ohio and Mississippi River Valleys are at greatest risk.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Port-A-Cath Lead Fracture and Intracardiac MigrationIatrogenic
- Cryptococcus gattii Presenting as Solitary Lung Nodule with LeptomeningitisInfection
- Twiddler Syndrome — ICD Lead Coiling and Proximal MigrationIatrogenic
- Large Cystic Mediastinal TeratomaNeoplastic
- Cystic Lung Disease Mimicking UIP — Possible Airspace Enlargement with Fibrosis (AEF)ILD
- Unexplained Symmetric Peribronchial Cystic Lung Disease in a Young West African WomanILD
- Unusual Bilateral Pleural Calcifications in a Young Man — Milk of CalciumOther
- Nocardia Pulmonary Infection in Stem Cell Transplant PatientInfection
See all cases from September 1, 2017 →