A case of relapsing polychondritis presenting as mediastinal syndrome, diagnosed by CT scans of the trachea and head

OBJECTIVE: The aim of this study is to evaluate the significance of CT scans of the trachea and head in the diagnosis of Relapsing Polychondritis (RP). DESIGN: Relapsing polychondritis is a disease involving cartilaginous structures, particularly those of the ears, nose and trachea. Diagnosis is based on specific clinical features and immuno-histopathological evaluation of the cartilages involved. SETTING AND PATIENTS: We describe a case of RP in which the most evident clinical signs (cough, dyspnoea, vertigo, tinnitus, headache, oedema of the face and shoulders and fever), led us first to suspect a mediastinal compression syndrome. INTERVENTION: A CT scan of the trachea and head revealed details which established the correct diagnosis, supported by other typical RP symptoms and by histopathological examination of the cartilage. MAIN OUTCOME MEASURES: Evaluation by CT scan of the chest, the mediastinum, the head and the pinnae. RESULTS: CT scanning revealed thickening and calcification of the anterolateral tracheal wall and main bronchi besides marked narrowing of the trachea. CT of the head showed calcification also of the external auditory meatus and part of the pinnae. CONCLUSION: We consider that CT scan of the trachea and head is helpful in evaluating the bronchial tree, the auditory meatus and pinnae as well as being a valid tool for the final diagnosis and in following the course of the disease.