Multimodality Imaging of Fibrosing Mediastinitis

Granulomatous and nongranulomatous fibrosing mediastinitis are presented and imaging findings, prognosis and treatment are reviewed.

Course ID: Q00600 Category:
Modalities: , ,

2.5

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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.50
Procedures: 2.50
Neck and Chest: 2.50

Magnetic Resonance Imaging: 1.75
Procedures: 1.75
Body: 1.75

Nuclear Medicine Technology: 0.50
Procedures: 0.50
Endocrine and Oncology Procedures: 0.50

Radiography: 1.75
Procedures: 1.75
Thorax and Abdomen Procedures: 1.75

Registered Radiologist Assistant: 1.75
Procedures: 1.75
Thoracic Section: 1.00
Neurological, Vascular, and Lymphatic Sections: 0.75

Vascular-Interventional Radiography: 1.75
Procedures: 1.75
Vascular Diagnostic Procedures: 1.00
Vascular Interventional Procedures: 0.75

Outline

  1. Introduction
  2. Granulomatous FM
  3. Nongranulomatous FM
  4. Imaging Modalities and Features of Granulomatous and Nongranulomatous FM
  5. Spectrum of Imaging Findings and Complications
    1. Airway Involvement
    2. Pulmonary Artery and Vein Involvement
    3. Systemic Vein Involvement
    4. Pleural Involvement
    5. Other Complications
  6. Differential Diagnosis
  7. Prognosis, Treatment, and Imaging Surveillance
  8. Conclusion

Objectives

Upon completion of this course, students will:

  1. recognize the different subtypes of FM
  2. identify the most common cause of granulomatous FM
  3. be familiar with the percentage of FM patients with the granulomatous subtype
  4. be familiar with the regions of the U.S. that are more likely to have a fungus endemic to that area
  5. be familiar with the percentage of FM patients with the nongranulomatous subtype
  6. be familiar with the age that patients are most commonly diagnosed with nongranulomatous FM
  7. be familiar with the immunologic reaction to diseases that lead to nongranulomatous FM
  8. identify the imaging modalities that are not useful for diagnosing FM
  9. understand the role that chest radiography plays in diagnosing FM
  10. identify the imaging modality of choice for diagnosing FM
  11. be familiar with the areas of the body affected by FM
  12. understand the potential role of MRI in diagnosing FM
  13. be familiar with the alternatives for catheter angiography
  14. be familiar with the role that conventional angiography plays in assessment of FM patients
  15. be familiar with what creates “golden pneumonia”
  16. be familiar with mosaic perfusion due to fibrous encasement of the central pulmonary arteries
  17. be familiar with the useful CT windows employed when imaging FM patients
  18. be familiar with the use of CT to make an accurate patient diagnosis
  19. identify the characteristic clinical features of SVC syndrome
  20. understand the role that nuclear medicine may play in patients with suspected SVC syndrome
  21. be familiar with the ability for CT to assist in patient diagnosis
  22. be familiar with the cause of chylothorax
  23. be familiar with the effects of fibrosis on the esophagus
  24. be familiar with the criteria for diagnosis for granulomatous FM
  25. recognize the significance of granulomatous calcifications in FM patients
  26. be familiar with the information that may be necessary for diagnosing nongranulomatous FM
  27. be familiar with the imaging modality appropriate for tissue sampling
  28. be familiar with the known patient complications of FM
  29. recognize the uncommon complications related to vascular stent placement
  30. be familiar with medical interventions in FM patients with airway compromise
  31. recognize the surgical interventions that may be necessary in FM patients
  32. be familiar with the diagnostic ability of CT to differentiate disease in FM patients
  33. be familiar with the serious outcomes resulting from FM
  34. be familiar with the tools used to monitor patients suffering with FM
  35. be familiar with new therapeutics to treat patients with FM