D107-08 Mediastinal Granuloma and Fibrosing Mediastinitis - A Case Series
Abstract
Mediastinal granuloma and fibrosing mediastinitis are both rare sequalae of Histoplasma exposure. Differentiating between these is important because management and prognosis differs significantly. We report a case series of 3 patients each, seen between July 2024 and October 2025 to highlight differences between these conditions.
Differentiating features observed between these two conditions were - patients with mediastinal granuloma tended to have history of exposure to marijuana, presence of fistulization on imaging, and absence of pleural effusion. Symptoms tended to be acute or subacute in mediastinal granuloma patients and chronic in fibrosing mediastinitis patients.
This abstract is funded by: None
Patients with mediastinal granuloma were younger (ages 21, 29 and 31) and presented with acute dyspnea, productive cough and fever with symptom duration varying from 1-4 weeks. All patients had a history of vaping/smoking tobacco and marijuana. Imaging showed large subcarinal lympadenopathy with calcifications with compression of distal bronchi in all patients. 2 patients also had hilar lympadenopathy (Station 11Ri). All patients had concern for fistulization (presence of gas bubbles inside the mediastinal lesion) and same was confirmed in 2 patients (visualized in OR / on barium swallow). All patients underwent bronchoscopic biopsy with EBUS and infectious work up. Pathology showed histiocytic aggregates with granulomas and giant cells suggesting acute on chronic…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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