*4.4.1 Mediastinal adenitis*

Most of the time, it is asymptomatic or paucisymptomatic, the most common symptoms being fever and pleuritic chest pain [17, 18]. However, an increase in the ganglia size can cause local obstruction through extrinsic compression, affecting the airways, the superior vena cava, or the esophagus, thus causing different symptoms: dyspnea, swallowing disorders, or cape edema. The radiological image is often suggestive. From an imaging point of view, mediastinal adenitis presents the appearance of mediastinal formation with solid density and homogeneous appearance on CT, in contrast to the heterogeneous appearance of granulomatous mediastinitis.

In isolated cases, pericarditis can also occur. Although this form is often selflimiting, a complete resolution of symptoms occurs after an extended period, from weeks to months. Imaging shows maintenance of the increased dimensions, and their calcification is frequent. Serology is often positive, thus confirming the diagnosis.

In the case of mediastinal adenitis, no specific treatment is recommended, but non-steroidal anti-inflammatory therapy is indicated to reduce pain or fever. However, if the clinical impact is important, specific antifungal treatment with Itraconazole is recommended to prevent disease progression and corticosteroids.

The differential diagnosis is most frequently made with mediastinal granuloma; in mediastinal adenitis, the characteristic is the homogeneous appearance, while in mediastinal granuloma, we have an enlargement of the ganglion with an inhomogeneous appearance [8].
