CTICasesChronic Pulmonary Histoplasmosis (Fibrocavitary Form)
Imaging findings
CT in an older male smoker with emphysema demonstrates right upper lobe cavitary lesions with thick walls, adjacent bronchiectasis, and surrounding parenchymal consolidation and nodularity, with spilling of infectious material, mimicking fibrocavitary non-tuberculous mycobacterial (NTM) disease. Cultures confirmed Histoplasma capsulatum.
Key takeaways
Chronic fibrocavitary pulmonary histoplasmosis is a rare manifestation of H. capsulatum infection that occurs in patients with underlying structural lung disease (typically emphysema) and closely mimics the classic fibrocavitary form of NTM disease or tuberculosis on CT. It should be considered in older patients with emphysema from endemic regions who do not grow mycobacteria from cultures and have upper lobe cavitary disease.
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