Computed tomography manifestations of fibrosing mediastenitis, an unusual cause of pulmonary symptoms: A case series

Abstract

Background: Fibrosing mediastenitis is a rare benign condition in which fibrous tissue proliferates invasively and progressively in mediastinum. It has two types: focal granulomatous and diffuse non-granulomatous form. It presents with diverse clinical presentations depending upon its complications. Contrast enhanced computed tomography is useful modality for diagnosis and assessing the extent and severity of involvement.Objective: The purpose of this study is to describe computed tomographic manifestations of fibrosing mediastenitis in eight pathologically proven cases of fibrosing mediastenitis.Methodology: In this study we describe the computed tomography findings in eight cases of pathologically proven fribrosing mediastinitis. Clinical data regarding the presentation and suspected etiology were correlated with location of mediastinal disease, presence of calcification, contrast enhancement, effect on structures of mediastinum and additional associated pulmonary findings on computed tomography.Results: The mean age of patients was 39 years, with two female and six male patients. Two patients had diffuse involvement of mediastinum and six patients presented with local mass. Calcification was present in five cases. There was no contrast enhancement in all eight cases. Six of eight cases revealed narrowing of mediastenal structures, with two cases showing pulmonary artery narrowing, three with superior vena cava obstruction, two with tracheal narrowing and one with pulmonary vein narrowing.Conclusion: Fibrosing mediastenitis is an unusual cause for commoncomplaints like cough, shortness of breath and chest pain. Familiarity with its different imaging features is crucial not only for accurate diagnosis as well as for planning noninvasive and surgical procedures. Computed tomography can play a vital role in its diagnosis, work up and follow up.