CTICasesPulmonary Histoplasmosis with Satellite Nodules
Imaging findings
CT shows a dominant right lower lobe pulmonary nodule with surrounding draining lymphatic satellite nodules (beaded vessels), associated with exuberant subcarinal lymphadenopathy demonstrating early/faint calcifications. PET/CT shows high metabolic activity in the subcarinal lymph node (flip-flop sign) and minimal activity in the lung nodule.
Key takeaways
Subacute pulmonary histoplasmosis commonly presents with a solitary nodule and surrounding satellite nodules along lymphatics, accompanied by prominent mediastinal lymphadenopathy. The "flip-flop sign" (disproportionately higher FDG uptake in the lymph nodes compared to the primary lung nodule) is a key diagnostic clue for fungal infection, helping avoid unnecessary oncologic workups.
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