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Imaging of pediatric mediastinal histoplasmosis
S G Kirchner1, M Hernanz-Schulman, S M Stein
1Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232-2675.
Abstract:
Histoplasmosis can present a diagnostic dilemma if unusually large masses of lymph nodes, invasive mediastinal fibrosis, or pericarditis result from the infection. These rare, late sequelae are often first suspected from findings on chest radiographs obtained for unrelated reasons. Organisms are not always evident at histologic analysis at this stage. Mediastinal granulomas consist of lobulated masses of enlarged lymph nodes with central caseation, a peripheral thin capsule, and, occasionally, calcification. The mass does not invade or compromise adjacent anatomic structures. Mediastinal fibrosis invades and can seriously compromise the function of the tracheobronchial tree, superior vena cava, pulmonary arteries and veins, and esophagus; its symptoms mimic those of many other disorders. Pericarditis is commonly accompanied by pericardial effusion, pneumonia, and adenopathy. Although the radiologic findings of these conditions are nonspecific, they can be used with the clinical findings to suggest a diagnosis. Complications of histoplasmosis should be included in the differential diagnosis for patients residing in areas endemic to Histoplasma capsulatum.
Insights
Rare complications of histoplasmosis, including mediastinal fibrosis and pericarditis, can mimic other conditions. Early recognition on chest radiographs is crucial for diagnosis in endemic areas.
Area of Science:
- Infectious Diseases
- Radiology
- Pathology
Background:
- Histoplasmosis, a fungal infection, can lead to rare, late-stage complications.
- These complications, including mediastinal granulomas, fibrosis, and pericarditis, may present diagnostic challenges.
Observation:
- Unusually large lymph node masses, invasive mediastinal fibrosis, or pericarditis can be late sequelae of histoplasmosis.
- Findings on chest radiographs are often nonspecific but can suggest the diagnosis when combined with clinical data.
Findings:
- Mediastinal granulomas are characterized by enlarged lymph nodes with central caseation and peripheral capsules.
- Mediastinal fibrosis invades and compromises vital structures, mimicking other disorders.
- Pericarditis associated with histoplasmosis may present with effusion, pneumonia, and adenopathy.
Implications:
- Histoplasmosis complications should be considered in the differential diagnosis for patients in endemic regions.
- Radiographic and clinical findings are key to suspecting these rare manifestations.
- Timely diagnosis is essential for appropriate patient management.