대한흉부영상의학회 Weekly Chest Cases

Case No : 1503 Date 2026-08-10

Courtesy of Sowon Jang, Minseon Kim / Seoul National University Bundang Hospital
Age/Sex 54 / M
Chief ComplaintChest pain

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Diagnosis With Brief Discussion

Diagnosis: Fibrosing mediastinitis
Radiologic Findings: Fig. 1. Contrast-enhanced chest CT shows an infiltrative soft-tissue lesion in the mediastinum, involving the left upper lobe.
Fig. 2. PET/CT shows avid FDG uptake in the infiltrative soft-tissue mediastinal lesion.
Fig. 3. MR imaging shows diffusion restriction and contrast enhancement in the infiltrative soft-tissue lesion in the mediastinum.
Fig. 4. Contrast-enhanced chest CT performed after 1 month shows an interval increase in the size of the infiltrative soft-tissue lesion in the mediastinum.
Brief Review: Fibrosing mediastinitis (FM), also called mediastinal fibrosis/sclerosing mediastinitis, is a benign but potentially progressive fibroinflammatory disorder characterized by infiltrative fibrous tissue that encases mediastinal structures and can cause clinically significant obstruction.
FM is broadly described as (1) a focal, granulomatous form—classically related to an idiosyncratic immune response after Histoplasma exposure in endemic regions—and (2) a diffuse, nongranulomatous form that may be idiopathic or associated with autoimmune conditions, prior radiation, and other systemic fibrosing disorders.
Clinically, manifestations depend on which structures are compromised. Major complications include airway encasement (atelectasis/postobstructive pneumonia), pulmonary artery/vein obstruction (oligemia, venous congestion, pulmonary hypertension/cor pulmonale), and SVC obstruction (SVC syndrome with collateral pathways).
On imaging, contrast-enhanced CT is the modality of choice, both for identifying calcification and for mapping the extent of visceral encasement and stenosis.
The granulomatous form often appears as a focal infiltrative mass with variable enhancement and dense/stippled calcification, sometimes with other signs of prior granulomatous infection (e.g., calcified granulomas, broncholithiasis).
References: 1. McNeeley MF, Chung JH, Bhalla S, Godwin JD. Imaging of Granulomatous Fibrosing Mediastinitis. AJR Am J Roentgenol. 2012;199:319–327.
2. Garrana SH, et al. Multimodality Imaging of Focal and Diffuse Fibrosing Mediastinitis. Radiographics. 2019.
Keywords

No. of Applicants : 77

▶ Correct Answer : 6/77, 7.8%

- Other , Korea (South) SEONGSU KANG
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Osaka University , Japan AKINORI HATA
- , Korea (South) HYOUNG YEOB KIM
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Ehime University , Japan KOTARO MATSUMOTO

▶ Correct Answer as Differential Diagnosis : 7/77, 9.1%

- University of Yamanashi , Japan HIROAKI WATANABE
- Chonbuk National University Hospital , Korea (South) YEEUN LEE
- Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
- Fukuoka university , Japan KEISUKE SATO
- Kantou Rousai Hospital , Japan KAORU SUMIDA
- Ehime University , Japan TOMOHISA OKADA
- Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO

▶ Semi-Correct Answer : 2/77, 2.6%

- , Japan MASAMICHI IWAI
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1503 Date 2026-08-10

Discussion

No. of Applicants : 77