CTICasesFibrosing Mediastinitis (Histoplasmosis vs. Sarcoidosis)
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Imaging findings
Prominent hilar enlargement and subtle interstitial prominence are noted. Very prominent Kerley B lines are visible. CT shows extensive mediastinal and hilar (subcarinal) lymphadenopathy with chunky calcifications. This causes significant airway narrowing, including total occlusion of the right lower lobe bronchus, leading to subsequent air trapping. The left inferior pulmonary vein is totally occluded, and the right superior pulmonary vein is markedly narrowed. Parenchymal nodules are also present.
Key takeaways
This is a classic example of fibrosing mediastinitis, causing severe airway and pulmonary venous obstruction. The chunky calcifications suggest a granulomatous etiology, with histoplasmosis and sarcoidosis considered in the differential. The case raises questions about potential interventions like stenting to open the compromised pulmonary veins.
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