A 30-year-old female patient presented to the clinic with intermittent haemoptysis for the past 2 years. She was a lifetime non-smoker, had no significant organic or inorganic dust exposures, and had not recently travelled. She reported progressively worsening dyspnoea and a chronic non-productive cough. There were no constitutional symptoms or a history of tuberculosis. 
 A review of her past medical history revealed that 2 years prior to consulting us, she presented to a different pulmonology unit following an episode of massive haemoptysis. Following extensive investigations, the only identifiable pathology was that of an enlarged right hilar lymph node. A biopsy of the lymph node was performed via a thoracotomy and revealed a hyalinising granuloma. The patient was lost to follow-up until her presentation to our unit. 
 No abnormal signs were elicited on physical examination. In particular, we found no clinical signs suggestive of tuberculosis, sarcoidosis, or connective tissue disease. Spirometry showed mild  restriction and a reduced diffusing capacity of the lung for carbon monoxide. A chest radiograph showed reduced volume of the right hemithorax and a right hilar mass-like opacity. Computed tomography found a prominent right bronchial arterial circulation with a distended bronchial artery, tortuous fifth to seventh intercostal arteries, and collateralisation of the pulmonary circulation. A right hilar soft tissue mass was found to be encasing the right pulmonary artery with resultant attenuation of the vessel (Fig. 1). Multifocal areas of ground-glass opacification were seen in the right upper and middle lobes with associated interlobular septal thickening consistent with pulmonary haemorrhage. The previous diagnosis of hyalinising granuloma was excluded after review of the radiology. 
 Microbiological examination of expectorated sputum was negative for tuberculosis, and cytological evaluation was unrevealing. Serological studies for histoplasmosis, Aspergillus and connective tissue disease were negative. Serum angiotensin-converting enzyme, IgG4 and calcium were within normal limits. 
 We proceeded to perform an endobronchial ultrasound with transbronchial fine-needle aspiration of the subcarinal component of the mass-like lesion. No endobronchial lesions were observed during the bronchoscopy, and all major and segmental airways were patent. The aspirate was evaluated by microscopic cytopathological examination, flow cytometry, mycology and mycobacterial culture. Cytopathological examination revealed a paucicellular aspirate with no evidence of malignancy or granulomatous disease, flow cytometry was normal, and microbiological culture examination was negative for tuberculosis and there was no growth on mycology culture. 
 A diagnosis of idiopathic fibrosing mediastinitis was made following consensus by a multi-disciplinary team, and on the basis of highly suggestive radiology (a constrictive, fibrosing lesion of the right hilum and adjacent mediastinal structures) and the exclusion of competing differential diagnoses. Treatment with high-dose oral corticosteroids  was initiated and the patient remains clinically stable without evidence of disease progression during follow-up care. She has had no further episodes of haemoptysis.