대한흉부영상의학회 Korean Society of Thoracic Radiology

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대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 372 Date 2004-12-11

  • Courtesy of Kyung Hee Lee, M.D. / Inha University Hospital, Gyungkido, Korea
  • Age/Sex 41 / M
  • Chief ComplaintAbnormal finding on chest radiograph (History of tuberculous lymphadenitis in 1994)
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Diagnosis With Brief Discussion

Diagnosis
Fibrosing Mediastinitis by mediastinoscopic Bx
Radiologic Findings
Initial chest PA shows mild superior mediastinal widening.

About two year follow up chest radiograph shows no change of superior mediastinal widening.

There is soft tissue mass in right paratracheal and precarinal area and SVC is not demonstrated on CT. The aortic nipple is prominent and left superior intercostal vein is dilated. On venogram, SVC and brachiocephalic vein are not visualized and collateral draining veins are noted.
Brief Review
Fibrosing mediastinitis (chronic sclerosing mediastinitis, granulomatous mediastinitis, or idiopathic mediastinal fibrosis ) is a rare condition characterized by chronic inflammation and fibrosis of mediastinal soft tissues. It can cause compression and sometimes obliteration of vessels, airways, and the esophagus and result in a variety of functional and radiologic manifestations and occasionally, death.

The exact pathogenesis of the mediastinal fibrosis is unclear, although tuberculosis, syphilis, histoplasmosis and blastomycosis have all been suggested as aetiological factors, as well as immune reactions, drugs, trauma and malignancy.

In 40% of patients the disease is discovered incidentally, but the rest have symptoms of compression of mediastinal structures the superior vena cava being the most common clinically, and it may mimic a malignant process. The disease is exceptionally rare in Europe, with most cases reported originating from the United States, where it is often associated with fungal infections, particularly histoplasmosis

Fibrosing mediastinitis typically manifests on CT scans as an infiltrative mass of soft-tissue attenuation obliterating normal mediastinal fat planes and encasing or invading adjacent structures. Fibrosing mediastinitis most commonly affects the middle mediastinal compartments, including both the paratracheal and subcarinal regions, and the hila.
References
Keywords
Mediastinum, Non-infectious inflammation,

No. of Applicants : 40

▶ Correct Answer : 25/40,  62.5%
  • - Aditya Imaging Centre, Baroda, India Vivek Patel
  • - Annecy Hospital, France Gilles Genin
  • - Apollo Hospitals, Colombo P.Xavier Rajesh
  • - ASL BOLOGNA Maggiore Hospital, Bologna, Italy Marcellino Burzi
  • - CHU Nancy-Brabois, France Denis Regent
  • - CIM Saint Dizier, France JC Leclerc
  • - Eulji hospital, Korea Jeong Joo Woo
  • - Ewha Womans University Mokdong Hospital, Korea Yoo Kyoung Kim
  • - Govt. Medical College, Vadodara , India Vijay Vaidya
  • - Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Hospital Universitario de Valme. Sevilla. Spain Marcos Sanchez Moreno
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Korea University Hospital, Korea Kyoung-Rae Kim
  • - Mallinckrodt Institute of Radiology, USA Jin Mo Goo
  • - Marien Hospital, Hamm, Germany Davis Chiramel
  • - National Taiwan University Hospital, Taiwan Sheng-Hsiang Lin
  • - Soonchunhyang University Cheonan Hospital, Korea Hae Seung Lee
  • - Shiga University of Medical Science, Shiga, Japan Kiyoshi Murata
  • - Shiga University of Medical Science, Japan Yukihiro Nagatani
  • - Stanley Medical College Hospital,Chennai,India. S.Ezhilan
  • - University Federal of Sao Paulo, Brazil Isabela Silva
  • - University of Colorado, USA Brian Petersen
  • - Ch-luneville, France Nicolas Michel
▶ Semi-Correct Answer : 9/40,  22.5%
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - Ev.Krkhs.Hubertus, Berlin, Germany D.-R. Meyer
  • - Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Samsung Medical Center, Korea Ha Young Kim
  • - Sharma Clinic, Jaipur, India Dinesh Sharma
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