CTICasesFibrosing Mediastinitis with Superior Vena Cava Obstruction
Imaging findings
Chest CT demonstrates narrowing and obstruction of the superior vena cava (SVC) with calcified right hilar lymph nodes. Secondary vascular findings include prominent systemic-to-pulmonary venous collaterals, chest wall and paraspinal collaterals, and intense focal enhancement of the hepatic quadrate lobe, representing the 'hot quadrate sign'.
Key takeaways
Fibrosing mediastinitis is a rare, benign, but clinically devastating fibroinflammatory process, most commonly caused by an abnormal host immune response to Histoplasma capsulatum. Severe narrowing of mediastinal structures like the SVC leads to extensive collateralization, with the 'hot quadrate sign' on abdominal imaging serving as a classic sign of SVC obstruction.
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