Case Author(s): Charles Pringle, M.D. and Farrokh Dehdashti, M.D. , 01/11/96 . Rating: #D3, #Q3

Diagnosis: Early fibrosing mediastinitis

Brief history:



Anterior, posterior, and lateral images

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View second image(ct). axial enhanced image through mediastinum

Full history/Diagnosis is available below

Diagnosis: Early fibrosing mediastinitis

Full history:

26-year old woman with two- week history of dysphagia. A recent CT scan showed a soft tissue mass in the mid esophagus and barium swallow showed an extrinsic compression upon the mid esophagus, with a smooth appearing mucosa of the esophagus in that area.


15.8 mCi F-18 fluorodeoxyglucose (FDG) i.v.


There is focally abnormal intense FDG accumulation in the region of the mid esophagus with an irregular appearance along the inferior and right lateral margins. This area does correspond to a soft tissue mass identified on CT scan, which could be due to a malignant process or an active inflammatory disease.


The CT scan findings of a soft tissue mass with some small calcifications and the barium swallow demonstrating extrinsic pressure upon the esophagus were most consistent with a granulomatous process and most likely represent early fibrosing mediastinitis.

References: 1) J Nucl Med 1992;33:1972-1980 2) J Nucl Med 1975;15:352-355


Patient was treated for presumed fibrosing mediastinitis.

Major teaching point(s):

The appearance of increased FDG accumulation in the region of the soft tissue mass is consistent with increased metabolism and can be present in active granulomatous processes in addition to neoplasm. The type of inflammatory responses are important in determining the degree of FDG uptake. Tuberculosis, fungal infections, and abscess have all been associated with increased FDG uptake. These infections are characterized by cellular infiltrates, granuloma formation, and macrophage proliferation. Activated inflammatory cells have a markedly increased glycosis and the hexose monophosphate shunt is stimulated by phagocytosis with increases of 20-30 times baseline being common in these cells.

Differential Diagnosis List

Active granulomatous disease, malignant tumor.

ACR Codes and Keywords:

References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Lung, Mediastinum, and Pleura, Category:Inflammation,Infection)

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Case number: pt008

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