Fibrosing mediastinitis

Case contributed by Dr Hani Salam

Presentation

Progressive dyspnoea.

Patient Data

Age: 25
Gender: Male
X-ray

Marked narrowing of the trachea is noted.

CT

Note is made of a heterogeneous soft tissue attenuation lesion in intimate relation to the trachea extending from the right paratracheal region just inferior to the lower pole of the right thyroid gland lobe with complete encasement of the mid to lower trachea as well as the proximal portion of both the right and main bronchi. The lesion extends caudally to the proximal portion of the right main bronchus. At the area of the maximum narrowing, the residual lumen is slit-like and measures 1.1 x 0.3 cm with a residual area of 0.3 cm2. The lesion is of soft tissue attenuation but heterogeneous with some areas of decreased attenuation, increased attenuation, sheath-like calcification, and scattered foci of calcification.

CT

3 Months follow up

No significant interval change.

Case Discussion

Pathology: Fibrosis and mild nonspecific chronic inflammation and early dystrophic calcifications.

Biopsy consists for the most part of lamellae of hyalinized collagen. No granulomas or necrosis seen. No amyloid. A possible diagnosis is sclerosing mediastinitis. 

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Case information

rID: 42864
Case created: 11th Feb 2016
Last edited: 13th Jun 2017
System: Chest
Inclusion in quiz mode: Included

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