CTICasesHistoplasmosis Presenting as Large Calcified Right Paratracheal Mass in a Child
Imaging findings
CT in a six-year-old demonstrates a large right paratracheal mass with extensive internal calcifications and multiple scattered tiny calcified granulomas. The mass is of substantial size, larger than typically expected from a residual histoplasma lymph node, and the degree of calcification is striking. A few scattered calcified pulmonary granulomas are also seen. Surgical resection was performed given the large mass with concern for malignancy, and pathology revealed histoplasmosis.
Key takeaways
Histoplasmosis in children can produce unusually large calcified mediastinal lymph nodes that may mimic other calcified masses and raise concern for malignancy. Children can develop calcification of histoplasma-infected nodes more rapidly than adults. The unusual size of the residual calcified node in this case surprised the group, as they had not expected histoplasmosis to produce nodes of that magnitude. In the endemic Ohio and Mississippi River Valley region, calcified mediastinal adenopathy in a child should include histoplasmosis prominently in the differential regardless of node size.
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