Table 1 Fibrosing mediastinitis and differential diagnoses
From: Imaging features and differential diagnoses of non-neoplastic diffuse mediastinal diseases
Clinical scenarios | DIAGNOSIS | DIFFERENTIAL DIAGNOSIS | ||||||
|---|---|---|---|---|---|---|---|---|
Fibrosing mediastinitis | Lymphoma | Castleman disease | Sarcoidosis | |||||
Granulomatous subtype | Nongranulomatous subtype | Erdheim-Chester | IgG-4 | |||||
IMAGING FEATURES OF FIBROSING MEDIASTINITIS AND DIFFERENTIAL DIAGNOSIS | X-ray Features | Focal calcified paratracheal, subcarinal or hilar mass ++ Widening of the mediastinum Distortion and obliteration of lines | Mediastinal widening Retrosternal filling Hilar enlargement | Mediastinal masses Displacement of adjacent structures Ipsilateral pleural effusion Periostal reaction | Mediastinal widening Mass effect Hilar lymphadenopathies Nodal and lung calcifications Reticulonodular opacities, lung fibrosis, traction bronchiectasis | |||
CT Features | Focal calcified paratracheal, subcarinal or hilar mass ++ Superior vena cava syndrome | Infiltrating soft tissue, rarely calcified Variable heterogeneous enhancement Pulmonary arterial hypertension and bronchial arteries hypertrophy Unilateral pulmonary oedema, lung volume loss, chronic post-obstructive pneumonitis, bronchiectasis | Periaortic infiltration extending to the pericardium, right coronary sulci and/or myocardium of the right atrium with pleural involvement Thickening of the peribronchovascular bundles and interlobular septae | Diffuse mass in the posterior mediastinum | Superior vena cava syndrome Lymphadenopathies, including internal mammary, axillary Pericardial, pleural (unilateral) effusion Calcification (post-treatment) Pulmonary nodule, mass-like consolidation, infiltrates | Solitary or multicentric infiltrative mediastinal mass, arborising calcifications Intense homogeneous enhancement and washout Lymph nodes Centrilobular nodules | Lymphadenopathies Perilymphatic nodules, micronodules of upper/mid lung distribution, lung fibrosis | |
MR Features | Heterogeneous T1 signal isointense to muscle Variable T2 signal Heterogeneous enhancement post-Gadolinium injection | Iso to hyperintense T1 relative to skeletal muscle Arborising calcifications as low T2 Enhancement post-Gadolinium injection Low ADC values | ||||||
CLINICAL AND IMAGING FEATURES OF EXTRA-THORACIC MANIFESTATIONS | Clinical Features | Superior vena cava syndrome | Non specific | Non specific | Riedel’s thyroiditis Retroperitoneal fibrosis Sclerosing cholangitis Autoimmune pancreatitis | +/- Palpable lymphadenopathies +/- Hepatosplenomegaly | Fluid retention | 50% asymptomatic Dry eyes Erythema nodosum Parotid enlargement |
Imaging Features | +/- retroperitoneal fibrosis | Bone pain Focal neurological involvement Exophthalmos Retroperitoneal fibrosis Hypophysal changes related to diabetes insipidus | CNS involvement Orbital pseudotumor Riedel thyroiditis Retroperitoneal fibrosis Autoimmune pancreatitis Sclerosing cholangitis | |||||