DOI: https://doi.org/10.36347/sasjm.2026.v12i05.006

Pages: 402-405

Fibrosing mediastinitis (FM) is an unusual fibro-inflammatory disorder of the mediastinum that often leads to obstruction of major mediastinal structures. While histoplasmosis is the most common cause in some regions, tuberculosis remains an important etiology in endemic areas. We present a 48-year-old man with a history of superior vena cava (SVC) syndrome who presented with progressive dyspnea. CT angiography demonstrated extensive mediastinal fibrous invasion with thrombosis of the SVC, azygos vein, and left brachiocephalic vein, accompanied by an extensive collateral venous network. Additionally, there was chronic pulmonary embolism involving the right pulmonary artery and bilateral interstitial lung abnormalities. Microbiological investigation confirmed tuberculosis by GeneXpert. This case underscores the role of CT angiography in diagnosing FM and identifying complications and highlights the importance of considering tuberculosis as an etiology in endemic settings.