Abstract
We present a patient with fibrosing mediastinitis mimicking bronchogenic carcinoma. A 32-year-old male patient admitted with cough and hemoptysis. There was no history of tuberculosis, prior respiratory disease. He had a diagnosis of hepatosteatosis and diabetes mellitus for two years. He had a smoking history of 8 pack-years. Vital signs, physical examination were normal. Apart from a high Glu:177 mg/dL, ESH:48 mm/hr, rutine laboratory analysis were normal. The chest radiograph revealed prominence of right hilum. Thorax CT revealed 4cm mass lesion in the right hilum and multiple mediastinal, right hilar conglomerated lymph nodes.
In PET-CT SUVmax of the hilar lesion was 9.74. Fiberoptic bronchoscopy showed mucosal distortion of right upper lobe. Mucosal biopsy was unremarkable. EBUS-TBNA biopsy revealed CD-45 positive normal lymphoid cells. Cervical mediastinoscopy was undiagnostic. Diagnostic thoracotomy confirmed the diagnosis of fibrosing mediastinitis. Hilar mass was a conglomerated lymph node showing dense hyalinised fibrous tissue with chronic inflammation. In the etiology, we thought that fibrosing mediasinitis results from a prior tuberculosis infection, since our country is endemic for tuberculosis. There is no proven effective medical therapy for fibrosing mediastinitis. Despite the fact we initiated both antituberculosis and systemic corticosteroid therapy after informing the patient. The patient is stable after two months of therapy.
- © 2011 ERS