CTICasesFibrosing Mediastinitis with SVC Obstruction
Imaging findings
A woman in her 20s has a densely calcified mediastinal mass focal around the SVC with a thrombosed or nearly thrombosed SVC, extensive venous collaterals (large internal mammary and mediastinal veins, dilated azygos and hemiazygos, diaphragmatic collaterals), and calcified pulmonary nodules. The disease is very focal at the SVC, and the SVC was surgically resected and reconstructed with a graft.
Key takeaways
Fibrosing mediastinitis, most often a fibroinflammatory reaction to prior histoplasmosis, characteristically produces a densely calcified mediastinal mass that encases and narrows veins, airways, and arteries, with calcified nodes and lung calcifications as clues. Surgical resection and reconstruction is unusual and generally avoided because manipulation can provoke rebound fibrosis, but extensive SVC obstruction with abundant collaterals prompted repair here; medical options include rituximab to suppress the immune response.
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