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Weekly Chest CasesArchive of Old Cases

Case No : 1317 Date 2023-01-16

  • Courtesy of Soojung Park / Korea University Anam Hospital
  • Age/Sex 54 / F
  • Chief ComplaintRight back and chest pain (onset: 1 year ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Fibrosing mediastinitis
Radiologic Findings
Fig 1. Chest PA shows no remarkable abnormal finding in the lung and bony thorax.
Fig 2-5. CT scans reveal an infiltrative mass lesion in the posterior mediastinum, right paravertebral area.
Fig 6. The mass shows low signal intensity on T2, T1 WI.

Biopsy reveals the ratio of IgG4 to IgG is about 10%
Pathologically, the diagnosis of IgG4-associated disease was ruled out since it didn't meet the diagnostic criteria.
Brief Review
Fibrosing mediastinitis is an uncommon benign disorder characterized by the proliferation of dense fibrous tissue within the mediastinum. The precise cause and pathogenesis of fibrosing mediastinitis remains elusive. The specific manifestation of fibrosing mediastinitis affects the structures involved and their function, such as complications in the airway, vascular structures, and pleura.
Radiographs may show nonspecific widening of the mediastinum, with distortion and obliteration of normally recognizable mediastinal interfaces or lines. Findings can be quite subtle and the extent of mediastinal involvement is frequently underestimated.
CT findings show an infiltrative mass of soft tissue attenuation. The mass obliterates normal mediastinal fat planes and encases or invades adjacent structures. Fibrosing mediastinitis commonly affects middle mediastinal compartment, including both right and left paratracheal, subcarinal, and hilar areas.
On MR, fibrosing mediastinitis shows intermediate signal intensity on T1-WI and variable intensity on T2-WI. Foci of relative hypointensity may be seen on both T1- and T2-WI, caused by calcification or by dense fibrotic scar.
References
1. Rossi SE, McAdams HP, Rosado-de-Christenson ML, Franks TJ, Galvin JR. Fibrosing mediastinitis. RadioGraphics 2001;21:737-757.
2. Tabotta F, Ferretti GR, Prosch H, Boussouar S, Brun A, Roos JE, et al. Imaging features and differential diagnoses of non-neoplastic diffuse mediastinal diseases. Insights Imaging 2020;11:111.
3. Jain N, Chauhan U, Puri SK, Agrawal S, Garg L. Fibrosing mediastinitis: when to suspect and how to evaluate? BJR Case Rep 2016;2:20150274.
Keywords

No. of Applicants : 98

▶ Correct Answer as Differential Diagnosis : 1/98,  1.0%
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
▶ Semi-Correct Answer : 37/98,  37.8%
  • - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - , Japan FUMINORI MIYOSHI
  • - The University of Tokyo Hospital , Japan WATARU GONOI
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) JAYOUNG MOON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan MIDORI UENO
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Korea University Guro Hospital , Korea (South) LEE DAKYONG
  • - Holy Family Hospital , India RAJESH GOTHI
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Kyoto University , Japan SHO KOYASU
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Kyoto university , Japan AKIHIKO SAKATA
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