Tan Ronald, Martires Joanne, Kamangar Nader
Department of Medicine, Olive View - UCLA Medical Center, Los Angeles, California, USA.
Department of Medicine, Olive View - UCLA Medical Center, Los Angeles, California, USA; Division of Pulmonary and Critical Care Medicine, Olive View - UCLA Medical Center, Los Angeles, California, USA.
J Clin Imaging Sci. 2016 Aug 23;6:32. doi: 10.4103/2156-7514.188958. eCollection 2016.
Fibrosing mediastinitis is a rare condition defined by the presence of fibrotic mediastinal infiltrates that obliterate normal fat planes. It is a late complication of a previous granulomatous infection, such as histoplasmosis or tuberculosis (TB). Due to its rarity, fibrosing mediastinitis is often under-recognized, and the clinical presentation is variable and dependent on the extent of infiltration or encasement of structures within the mediastinum. We present a case of fibrosing mediastinitis in a man with a prior history of TB, who presented with progressive dyspnea and was found to have chronic mediastinal soft tissue opacities and pulmonary hypertension. His diagnosis was delayed due to the lack of recognition of this clinical/radiographic entity. Fibrosing mediastinitis is a rare entity usually caused by granulomatous disease. Most cases develop as a late complication of histoplasmosis or TB. The presence of calcified mediastinal soft tissue infiltrates on advanced chest imaging can be diagnostic of fibrosing mediastinitis in patients with a prior history of a granulomatous infection once active processes such as malignancy are excluded.
纤维性纵隔炎是一种罕见疾病，其定义为存在纤维化纵隔浸润，致使正常脂肪平面消失。它是既往肉芽肿性感染（如组织胞浆菌病或结核病）的晚期并发症。由于其罕见性，纤维性纵隔炎常常未得到充分认识，临床表现多样，且取决于纵隔内结构浸润或包绕的程度。我们报告一例有结核病病史的男性纤维性纵隔炎病例，该患者出现进行性呼吸困难，胸部影像学检查发现慢性纵隔软组织混浊及肺动脉高压。由于对这种临床/影像学表现缺乏认识，其诊断被延误。纤维性纵隔炎是一种罕见疾病，通常由肉芽肿性疾病引起。大多数病例是组织胞浆菌病或结核病的晚期并发症。对于有肉芽肿性感染病史的患者，一旦排除恶性肿瘤等活跃病变，胸部影像学检查显示纵隔软组织浸润钙化可诊断纤维性纵隔炎。
