Anterior mediastinal lesions in TAFRO syndrome: potential clinical significance

Infiltrative anterior mediastinal lesions are reportedly a characteristic CT finding of thrombocytopenia, anasarca, fever, reticulin fibrosis and organomegaly (TAFRO) syndrome. The present study aimed to explore their potential clinical value in TAFRO syndrome.

The present study reviewed cases of TAFRO syndrome and idiopathic multicentric Castleman disease-not otherwise specified (iMCD-NOS) diagnosed at Tokyo Metropolitan Tama Medical Center between 2007 and 2024. Body CT images were analysed for the presence of anasarca, organomegaly, lymphadenopathy and anterior mediastinal and lung lesions. Additionally, CT images of patients who were admitted for a fever of unknown origin (FUO) between 2018 and 2024 and later received a diagnosis of a malignancy or autoimmune disorder were assessed for these findings.

Twelve, 11 and 22 patients with TAFRO syndrome, iMCD-NOS and FUO, respectively, were included. Seven patients with TAFRO (58%) and one patient with iMCD-NOS (9%) had an anterior mediastinal lesion. Only one of the 22 patients with a FUO had an anterior mediastinal lesion (5%).

Anterior mediastinal lesions were more frequently observed in patients with TAFRO syndrome than in those with iMCD-NOS or FUO. This finding may be useful in diagnosing TAFRO syndrome and distinguishing it from iMCD-NOS and FUO.