대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 283 Date 2003-03-29

  • Courtesy of Eun-Young Kang, M.D. / Korea University Guro Hospital, Seoul, Korea
  • Age/Sex 67 / F
  • Chief ComplaintFacial flushing and edema for 2 months. Chest discomfort, upper extremity edema, hoarseness, headache, and visual disturbance for 1 month.
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Diagnosis With Brief Discussion

Diagnosis
Fibrosing Mediastinitis
Radiologic Findings
Chest radiograph shows widening of superior mediastinum and small pleural effusion in lower left hemithorax. Enhanced CT scans show soft tissue density encircled SVC with SVC narrowing. Poorly defined, soft tissue densities are noted in superior mediastinum with vascular obliteration of left innominate vein. Mediastinal fat is also prominent in superior mediastinum. Collateral vessels are seen in right chest wall.

Preoperative angiogram shows complete obliteration of lumen of SVC and both innominate veins with extensive collateral vessels. Shunt operation with excisional biopsy was done. Excisional biopsy of soft tissue lesion demonstrates compatible findings with fibrosing mediastinitis. TB-PCR from biopsy specimen was negative.
Brief Review
Fibrosing mediastinitis is a rare benign disorder characterized by chronic inflammation and fibrosis of mediastinal soft tissues. Causes of fibrosing mediastinitis include histoplasmosis, tuberculosis, other chronic infections, drug, radiation therapy, autoimmune disease, idiopathic. Two patterns of fibrosing mediastinitis are present: focal and diffuse. The focal type usually manifests as a localized, calcified mass in the paratracheal or subcarinal regions of the mediastinum or in the pulmonary hila. The diffuse type manifests as a diffusely infiltrating, often noncalcified mass that affects multiple mediastinal compartments. Fibrosing mediastinitis can cause compression and obliteration of vessels, airways, and the esophagus and result in a variety of functional and radiologic manifestations. CT and MR imaging are good methods of diagnosing and assessing the management of fibrosing mediastinitis.
References
1. Fraser RS, Muller NL, Colman N, Pare PD. Fraser and Pare's Diagnosis of diseases of the chest. 4th ed., W.B. Saunders company, Philadelphia. 1999:2856-2863
2. Rossi SE, McAdams HP, Rosado-de-Christenson ML, Franks TJ, Galvin JR. Fibrosing mediastinitis. Radiographics. 2001;21:737-757
Keywords
Mediastinum, Non-infectious inflammation,

No. of Applicants : 39

▶ Correct Answer : 21/39,  53.8%
  • - CHRU Lille, France Philippe Dumont
  • - CHU Nancy-Brabois, France Denis Regent
  • - Chung Li Ten-Chen Hospital,Taiwan Gui-Lin Zheng
  • - Chungju Hospital Konkuk University, Korea Chang Hee Lee
  • - Dept of IM, Seoul National University Hospital, Korea Changmin Choi
  • - Ewha Womans' University Hospital, Korea Sung Shine Shim
  • - GeumGang Asan Hospital, Korea Ju Youn Park
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Jecheon Public Health Center, Korea Seung Hun Ryu
  • - Korea University Hospital, Korea Bo Kyung Je
  • - Maimonides Medical Center, New York, USA Naomi Twersky
  • - National Medical Center, Korea Sang Kyu Yang
  • - National Taiwan University Hospital, Taiwan Kao-Lang Liu
  • - Ohio State University, Ohio, USA Sumit Seth
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Prever-Centro Radiologico, Brazil Arismar Leon Pereira
  • - Samsung Medical Center, Korea Yeon Joo Jeong
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - SUN Hospital, Uiwang, Korea Ki Taek Hong
  • - Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
▶ Semi-Correct Answer : 18/39,  46.2%
  • - Annecy Hospital, France Gilles Genin
  • - Calmette Hospital, Lille, France Raphael Nicolas
  • - Calmette Hospital, Lille, France Ralph Uzanoski
  • - CHU Grenoble, France Mathieu Rodiere
  • - Dept of IM, Seoul National University Hospital, Korea Jae-Joon Yim
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Hanyang University Hospital, Korea Mi Jeong Jang
  • - Hanyang University Hospital, Korea Seunghun Lee
  • - Korean National Institute of Health, Korea Sang-Min Lee
  • - Maimonides Medical Center, New York, USA Jack Twersky
  • - MH(CTC), Pune, India Vivek Sharma
  • - Narayana Hrudayalaya, Bangalore, India PG Sridhar
  • - Narayana Hrudayalaya, Bangalore, India Nisha Sreenivasan
  • - Samsung Medical Center, Korea Sun Young Jeong
  • - Seoul National University Hospital, Korea Jung-Gi Im
  • - Shinmasan Hospital, Korea Jung Kyung Hwa
  • - Sunlin Hospital. Pohang, Korea Won Hyuk Shin
  • - Ulsan University Hospital, Korea Kwang-Won Seo
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