Discussion
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,