Aspergillus fibrosing mediastinitis presenting as anterior mediastinal mass and massive pericardial effusion

Fibrosing mediastinitis (FM) is a rare disorder which is characterized by dense proliferation of fibrous tissue within the mediastinum surrounding and causing obliteration of the vital mediastinal structures, most commonly the superior vena cava. To date, the primary pathophysiology is not known however it has been associated with a wide spectrum of diseases ranging from infections such as histoplasmosis and granulomatous diseases such as tuberculosis and sarcoidosis to autoimmune disorders and malignancies. Therefore, early histopathological diagnosis of this rare disorder is crucial and requires a computed tomography scan to determine the extent of the disease within the mediastinum. We report a case of a 14-year-old male, who presented to us with initial impression of an anterior mediastinal mass due to malignancy and a massive pericardial effusion. However, he was later diagnosed as a case of fibrosing mediastinitis from aspergillosis on histopathology and fungal culture.