J Korean Soc Radiol.  2016 Jun;74(6):403-406. 10.3348/jksr.2016.74.6.403.

Localized Fibrosing Mediastinitis Causing Pulmonary Infarction: A Case Report

• Sur YK
• Kim EY
• Kang DK
• Park KJ
• Koh YW
• Sun JS

• KMID: 2164819
• DOI: http://doi.org/10.3348/jksr.2016.74.6.403

Abstract

A 44-year-old female patient visited our emergency room for hemoptysis and refractory chest wall pain of 2 months duration. She had no history of smoking or other medical conditions. Chest CT scan showed homogenously enhancing soft tissue mass without calcification at the left pulmonary hilum. Encasing and compression of the left lower pulmonary artery by the mass had resulted in pulmonary infarction in the left lower lobe. Laboratory tests for tuberculosis, fungus, and vasculitis were all negative. The patient underwent surgical biopsy and resection of infarcted left lower lobe that was histopathologically confirmed as fibrosing mediastinitis. Herein, we reported a rare case of surgically confirmed and treated localized fibrosing mediastinitis causing pulmonary infarction.

MeSH Terms

Adult
Biopsy
Emergency Service, Hospital
Female
Fungi
Hemoptysis
Humans
Mediastinitis*
Pulmonary Artery
Pulmonary Infarction*
Smoke
Smoking
Thoracic Wall
Tomography, X-Ray Computed
Tuberculosis
Vasculitis
Smoke

Figure

• 

  Fig. 1 Plain chest radiograph shows patchy increased opacity in left lower lung zone (arrows) and small amount of left pleural effusion.

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  Fig. 2 Representative CT images of localized fibrosing mediastintis. A. Preoperative post-contrast chest CT demonstrates mediastinal soft tissue mass extending into left hilar region and encasing left lower pulmonary artery, causing severe stenosis or occlusion (white arrows). B. Multifocal wedge shaped consolidations with surrounding ground glass attenuation at subpleural area of left lower lobe suggesting pulmonary infarctions (yellow arrows).

• 

  Fig. 3 Gross and microscopic specimens of localized fibrosing mediastintis. A. Photograph of cut surface of resected specimen demonstrates dense whitish fibrous tissue (white arrows) in left pulmonary hilum along the bronchovascular bundle with peripheral pulmonary infarctions (black arrows). B. High-power photomicrograph (original magnification, × 100, hematoxylin-eosin stain) of peripheral lung demonstrates extensive dense fibrosis. C. High-power photomicrograph (original magnification, × 100, hematoxylin-eosin stain) of left pulmonary hilum shows granulomatous inflammation (yellow arrows) with necrosis.

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