A case with multifocal masses

A 70-year-old man presented with progressive dyspnea, chest and back pain, fatigue of 5 years' duration, and dysphagia and weight loss of 1 year's duration. Despite multiple diagnostic work-ups performed previously, no eventual diagnosis could have been made. His personal past history was remarkable for impaired vision and recurrent "pneumonias" over the last 3 years. Computed tomography revealed mediastinal, right pulmonary, and retroperitoneal masses. The mediastinal mass compressed and obstructed the airways, superior vena cava, right main pulmonary artery, and esophagus, whereas the retroperitoneal mass encased inferior vena cava, abdominal aorta, and ureters. Transbronchial needle aspiration and endobronchial biopsy by rigid bronchoscopy and surgical biopsies of the mediastinal and pulmonary masses all showed inflammatory fibrous tissue. Ophthalmologic examination revealed a right orbital pseudotumor. A diagnosis of multifocal fibrosclerosis was made and corticosteroid treatment started. However, the patient died 2 weeks after establishing the diagnosis.