Pediatric Histoplasmosis

Etiology: Histoplasma capsulatum with endobronchial spread
Imaging:
— Hilar lymphadenopathy with calcification
— Bilateral lung nodules of various sizes (but bigger than miliary in size) with irregular margins and calcification
— Infiltrates with tree in bud appearance (endobronchial spread)
— Splenic calcification
DDX: Tuberculosis – histoplasmosis has greater number of parenchymal lesions
Complications:
Treatment:
Clinical:

Radiology Cases of Histoplasmosis

CXR of histoplasmosis — CXR PA and lateral shows bilateral hilar lymphadenopathy, right greater than left, and small miliary nodules throughout the lungs.

CT of histoplasmosis — CT with contrast of the chest shows bilateral hilar adenopathy.

CT of histoplasmosis — Coronal CT with contrast of the chest (left) shows a large round soft tissue nodule with a calcified center in the lateral aspect of the left hemithorax. Axial CT (above right) shows calcified mediastinal lymph nodes near the descending aorta and better demonstrates the calcification in the lung nodule (below right).

CXR and US of pericardial effusion due to histoplasmosis — AXR (above left) shows hepatomegaly and an enlarged cardiac silhouette. CXR (above right) shows a water-bottle appearance to the cardiac silhouette and bilateral pleural effusions and bilateral hilar lymphadenopathy. Transverse US of the heart (below) shows a large anechoic fluid collection in the pericardial space.

CXR and CT of pericardial effusion due to histoplasmosis — CXR AP (above left) shows a large cardiac silhouette and an abnormal contour to the right superior mediastinum. Coronal CT with contrast of the chest (above right) shows a huge fluid collection in the pericardial space and a conglomeration of cystic lymph nodes in the right superior mediastinum. Axial CT (below) shows the pericardial fluid collection completely surrounding the heart and left lower lobe atelectasis.