Correct!
4. 1 and 3
Repeat bronchoscopy might be necessary although it is premature at this time. Histoplasmosis is a common cause of mediastinal calcifications in the Midwest where she had traveled but the serology was negative. The repeat thoracic CT scan is shown in Figure 2.
Figure 2. Representative images from the repeat thoracic CT scan in soft tissue windows.
The interpretation of the CT scan was “Infiltrative soft tissue resulting in occlusion of the central brachiocephalic veins with internal areas of calcification. The soft tissue lesion is obliterating the superior vena cava. Multiple collateral venous channels within the anterior mediastinum and upper chest wall are noted. Portions of the right upper lobe pulmonary veins appear narrowed. Distal periaortic venous collaterals via the azygous an hemiazygos systems are noted”.
Because of the mediastinal masses, a positron emission tomography CT scan (PET/CT) was ordered (Figure 3).
Figure 3. Representative images from thoracic PET/CT scan.
The PET/CT was interpreted as showing “In the right paratracheal mediastinum there is an approximately 4.9 x 3.8 x 2.8 hypermetabolic mass with maximum SUV of 8.1. The mass is compressing the SVC and superior border of the right atrium The lesion has enlarged slightly since 4/26/2019”.
What is the most likely diagnosis? (Click on the correct answer to be directed to the 5th of 7 pages)