CTICasesUnicentric Castleman's Disease (Hilar Vascular Type)
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Imaging findings
A young patient presented with an abnormal, hypervascular, and intensely enhancing opacity in the right hilum, projecting posterior to the right hilar vascular opacity on the lateral view. There was also subtle tenting along the minor fissure. Multiple bronchoscopic and CT-guided core biopsies consistently yielded only normal-appearing lymphocytes, with no monoclonal population identified. The lesion has been stable over a couple of years. The hypervascularity and lack of definitive diagnosis from biopsy, coupled with stability, strongly suggest unicentric Castleman's disease (hilar vascular type). Recruit ed bronchial arteries supplying the mass are visible.
Key takeaways
Unicentric Castleman's disease, particularly the vascular type, typically presents as a hypervascular, intensely enhancing mediastinal or hilar mass. Diagnosis can be challenging as biopsies often show non-specific lymphoid tissue. Long-term stability and characteristic vascularity in the appropriate clinical setting can support a presumptive diagnosis, often requiring surgical excision for definitive confirmation. Recruitment of bronchial arteries is a common finding.
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