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Weekly Chest CasesArchive of Old Cases

Case No : 501 Date 2007-06-01

  • Courtesy of Kun Young Lim, MD, Su Hyun Lee, MD, Hyae Young Kim, MD. / National Cancer Center, Korea
  • Age/Sex 60 / F
  • Chief ComplaintCough, dyspnea (3MA)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Fibrosing mediastinitis (focal pattern)
Radiologic Findings
Contrast-enhanced axial CT scans show a soft-tissue attenuation mass encasing and narrowing the right main pulmonary artery. Subcarinal lymphadenopathy is also noted.
Mediastinoscopic biopsy was done. The pathologic examination revealed chronic nonspecific inflammation and fibrous tissue.
Brief Review
Fibrosing mediastinitis is an uncommon benign disorder characterized by proliferation of dense fibrous tissue within the mediastinum. The precise cause and pathogenesis of fibrosing mediastinitis in most cases is unknown, and links to infectious and noninfectious causes ramain speculative. Most patients present with signs or symptoms related to obstruction or compression of vital mediastinal structures such as the central airways, superior vena cava, pulmonary veins, pulmonary arteries and esophagus. The most common presenting complaints include cough, dyspnea, recurrent pulmonary infection, hempotysis, and pleuritic chest pain.
Sherrick et al identified two patterns of involvement on CT scans: a focal pattern and a diffuse pattern. The focal pattern, seen in 82% of cases, manfests as a mass of soft-tissue attenuation that is frequently calcified (63% of cases) and is usually located in the fight paratracheal or subcarinal regions or in the hila. This type of fibrosing mediastinitis is, in all probability, caused by histoplasmosis in patients from the United States. The diffuse pattern, seen in 18% of cases, manifests as a diffusely infiltrating, noncalcified mass that affects multiple mediastinal compartments. The diffuse pattern is probaly not related to histopsmosis but often occurs in the setting of other idiopathic fibrosing disorders such as retoperitoneal fibrosis.
References
1. Sherrick AD, Brown LR, Harms GF, Myers JL. The radiographic findings of fibrosing mediastinitis. Chest 1994; 106:484-489
2. Santiago E. Rossi, MD, H. Page McAdams, MD, Melissa L. Rosado-de-Christenson, Col, USAF, MC, Teri J. Franks, MD and Jeffrey R. Galvin, MD. Fibrosing Mediastinitis. Radiographics 2001; 21:737-757
Keywords
Mediastinum, Non-infectious inflammation,

No. of Applicants : 43

▶ Correct Answer : 6/43,  14.0%
  • - PGIMER, Chandigarh, India Ram Prakash Galwa
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Escprts Heart Institute New Delhi, India Monika Aggarwal
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - Annecy hospital, France Gilles Genin
  • - Dae-gu Fatima Hospital, Korea Tae-Hun Kim
▶ Correct Answer as Differential Diagnosis : 6/43,  14.0%
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - Vital imaging centre, Mumbai, India Ganesh Agrawal
  • - China Medical University Hospital, Taiwan Jun-Jun Yeh
  • - IRSA La Rochelle, France Jean-Luc BIGOT
  • - Doctors Hospital, Nassau, Bahamas N.B.S. Mani
▶ Semi-Correct Answer : 19/43,  44.2%
  • - Depart of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Registrar in Radiology, UHL NHS Trust, UK A. Donuru
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - Ruby Hall Clinic, Pune, India John Joseph
  • - National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
  • - Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
  • - Sotiria Hospital Athens Greece Delaveri kaith
  • - Sctimst trivandrum, kerala, India Santhosh Kannath
  • - Armidale Radiology, Australia Saurabh Khandelwal
  • - Australia Julie Arora
  • - E-Da hospital, Taiwan Yu-Feng Wei
  • - ANNEMASSE, Polyclinique de SAVOIE, France Gay-Depassier Philippe
  • - EKH-Berlin, Germany Michael Weber
  • - Nassau, Bahamas C. V. Subbarao
  • - Nassau, Bahamas Trupti dabholkar
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Aims, New Delhi, India Ashish Gupta
  • - CHU Grenoble, France Bing Fabrice
  • - Homs National Hospital, Homs - Syria Rami Abou Zalaf
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