WWWTP #15 Answer…

March 31, 2014


Several days ago this CXR was posted:


This CXR has several interesting findings.  There is a heavily calcified mass in the left hilar region consistent with a calcified lymph node.  Also there are multiple discreet nodules in the lung parenchyma (best one is seen in the left upper lobe, also well seen in right middle and upper lobes). 

Turns out this patient had lived in the midwest region for most of his life.  This pattern can be seen with Histoplasmosis. 

Histoplasma capsulatum is a fungus that is highly prevalent in the Ohio and Mississippi valleys of the midwest.  Radiographically it commonly causes solitary pulmonary nodules, multiple tiny nodules (miliary Histoplasmosis), and lymphadenopathy.  Less commonly it can cause fulminant pneumonia.  The differential diagnosis, depending on the radiographic findings, can include Mycobacterium tuberculosis, Coccidioidomycosis, lung cancer, lymphoma, sarcoidosis, and others. 

Author:  Russell Jones, MD

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EMREMS: Radiology in Emergency Medicine

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