PMC6385839_01
Posterior-Anterior (PA) chest X-ray. There is an ill-defined opacity in
the right lower lung zone, with some degree of fine reticulation,
extending to the lung periphery (Kerley B lines).
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Chest X-ray showed a right lower lobe opacity (Figure 1).
A: Axial contrast-enhanced lung CT (mediastinal windows): There is a soft
tissue attenuation mass at the level of the right lower pulmonary veins.
The lesion abuts the posterolateral part of the right atrium. The mass
exhibits coarse calcifications in its posterior part. Note the presence
of a calcified bronchopulmonary node on the right, which could be
attributed to a previous granulomatous infection. B: High resolution CT
scan (lung windows) at the level of the lung bases, depicting thickened
interlobular septa, patchy ground glass opacities and infiltrates,
consistent with regional lung congestion due to impaired pulmonary
venous return.
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A chest computed tomography (CT) scan (Figure 2) revealed a solid mass, measuring 7 mm in diameter, in the lower part of the posterior mediastinum, extending 6.3 cm downwards from the level of the carina.
A: Axial T1-weighted image. The mass is almost isointense to the thoracic
muscles (white asterisk). B: Coronal gradient-echo T2 image. The mass
extends upward to the subcarinal region. The lesion exhibits a
heterogeneous hypointensity (white asterisk), consistent with the
presence of fibrous component. C: Axial T1-weighted image,
post-gadolinium image. The mass (black asterisk) shows contrast uptake,
more homogeneous in its anterior part. Note that the uptake is less
homogeneous in its posterior part. Contrast uptake may represent areas
with active inflammation.
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Subsequently a chest magnetic resonance imaging (MRI; Figure 3), confirmed the presence of the space occupying lesion, extending to the subcarinal region.
Haphazardly arranged collagen lamellae separated by an inflammatory
infiltrate.
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The pathologic examination revealed dense bands of collagen separated by a chronic inflammatory cell infiltrate of lymphocytes and plasma cells (Figure 4).
Post-treatment, follow-up, axial T1-weighted, post gadolinium image. The
mass has smaller dimensions and the contrast uptake is less intense
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A new MRI scan was repeated nine months after the previous one, which showed that the dimension of the lesion remained unchanged (Figure 5).