A case report of tuberculous fibrosing mediastinitis: focusing on the diagnostic value of three-dimensional reconstruction from pulmonary contrast-enhanced CT and bronchoscopic features.

BACKGROUND: Fibrosing mediastinitis (FM) is a rare disease characterized by excessive fibrotic tissue proliferation in the mediastinum, often leading to compression of vital structures. Tuberculosis is a common cause in certain regions. Diagnosis is challenging due to non-specific symptoms. This report explores the integrated diagnostic value of advanced three-dimensional (3D) computed tomography (CT) reconstruction and bronchoscopy in tuberculous fibrosing mediastinitis (TFM).

CASE DESCRIPTION: A 69-year-old female presented with a 2-year history of progressive exertional dyspnea. Chest contrast-enhanced CT revealed mediastinal soft tissue infiltration, calcified lymph nodes, and right middle lobe opacities. 3D reconstruction from the CT data precisely demonstrated occlusion of the right middle lobe medial segmental bronchus, severe stenosis of the lateral segmental and right lower lobe dorsal segmental bronchi, and an extrinsic "knife-cut" stenosis of the right main pulmonary artery. Bronchoscopy confirmed multiple distorted and occluded bronchi with anthracotic pigmentation. Mycobacterium tuberculosis complex nucleic acid was detected in bronchoalveolar lavage fluid. The patient was diagnosed with TFM and showed symptomatic improvement after initiating anti-tuberculosis therapy combined with corticosteroids.

CONCLUSIONS: The integration of pulmonary contrast-enhanced CT 3D reconstruction with bronchoscopic evaluation provides a powerful, minimally invasive approach for diagnosing TFM. This multimodal strategy enhances the visualization of complex mediastinal involvement, aids in differential diagnosis, and can critically inform management decisions to avoid unnecessary high-risk procedures.