Zhang Mengdi, Bu Chao, Jiang Kaiyu, Long Xiaozhou, Sun Zhonghua, Cao Yunshan, Li Yu
Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, 628 Zhenyuan Rd., Guangming District, Shenzhen, China. 518107.
Department of Cardiology, Pulmonary Vascular Disease Center, Gansu Provincial Hospital, Lanzhou 730000, China.
Curr Med Imaging. 2025;21:e15734056324457. doi: 10.2174/0115734056324457241218113104.
Fibrosing mediastinitis (FM) is a rare and benign disease affecting the mediastinum and often causes pulmonary hypertension (PH). Timely diagnosis of PH caused by FM is clinically important to mitigate complications such as right heart failure in affected individuals. This retrospective study aimed to analyze the CT imaging characteristics of tuberculosis (TB) related FM in patients with (TB). Additionally, the study investigates the underlying reasons contributing to the manifestation of symptoms.
From April 2007 to October 2020, high-resolution CT (HRCT) and dual-phase CT pulmonary angiography images of 64 patients with suspected FM diagnosed with PH at a tertiary hospital were examined. The imaging characteristics of these CT scans were analyzed, with a specific focus on the TB-FM involvement of the pulmonary veins, pulmonary arteries, and bronchi (down to the segment level).
HRCT imaging revealed that fibrous tissue inside the mediastinum exhibited minimal or negligible reinforcement in TB-FM and diffuse fibrous infiltration in the mediastinum and hilar areas. Notably, segmental bronchial and pulmonary artery stenosis are more pronounced and frequently co-occurring than lobe-level stenosis. Pulmonary venous stenosis developed outside the pericardium, whereas pulmonary artery stenosis occurred outside the mediastinal pleura. Furthermore, no isolated FM involvement in pulmonary veins was noticed in this cohort.
HRCT imaging of TB-related FM presents unique features in certain regions of the bronchi, pulmonary veins, and pulmonary arteries. Thus, it is imperative to accurately identify fibrous tissue involvement in mediastinal lesions for proper diagnosis and management of TB-FM.
纤维性纵隔炎（FM）是一种罕见的良性疾病，累及纵隔，常导致肺动脉高压（PH）。及时诊断由FM引起的PH对于减轻受影响个体的并发症（如右心衰竭）在临床上具有重要意义。本回顾性研究旨在分析结核病（TB）相关FM患者的CT影像特征。此外，该研究还调查了导致症状表现的潜在原因。
2007年4月至2020年10月，对一家三级医院诊断为PH的64例疑似FM患者的高分辨率CT（HRCT）和双期CT肺动脉造影图像进行了检查。分析了这些CT扫描的影像特征，特别关注TB - FM对肺静脉、肺动脉和支气管（直至段水平）的累及情况。
HRCT影像显示，在TB - FM中纵隔内的纤维组织强化极少或可忽略不计，纵隔和肺门区域有弥漫性纤维浸润。值得注意的是，段支气管和肺动脉狭窄比叶级狭窄更明显且更常同时出现。肺静脉狭窄发生在心包外，而肺动脉狭窄发生在纵隔胸膜外。此外，该队列中未发现孤立的肺静脉FM累及情况。
TB相关FM的HRCT影像在支气管、肺静脉和肺动脉的某些区域呈现出独特特征。因此，准确识别纵隔病变中的纤维组织累及情况对于TB - FM的正确诊断和管理至关重要。
