CTICasesPulmonary Histoplasmosis with Satellite Nodules
Imaging findings
CT shows a dominant right lower lobe pulmonary nodule surrounded by tiny satellite nodules marching along the draining lymphatics, accompanied by prominent FDG-avid subcarinal and hilar lymphadenopathy (which can mimic a malignant mass). Antigens and antibodies confirmed histoplasmosis.
Key takeaways
Pulmonary histoplasmosis can present as a solitary pulmonary nodule with surrounding lymphatic satellite nodules. The disproportionate size of the mediastinal and subcarinal lymphadenopathy relative to the primary nodule is a characteristic morphologic clue that suggests granulomatous fungal infection rather than lung cancer, especially in young patients in endemic areas.
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