CTICasesAcute Histoplasmosis with Pulmonary Infarct
Imaging findings
The initial radiograph shows a peripheral wedge-shaped area of consolidation and a small pleural effusion. CT angio reveals right hilar lymphadenopathy, an area of consolidation with central low attenuation consistent with a pulmonary infarct, and a dominant nodule in the superior segment of the right lower lobe with numerous satellite nodules along vessels and lymphatics. Over two years, the upper lobe process scars down, and the right lower lobe nodule and hilar lymph nodes become thoroughly calcified.
Key takeaways
Acute histoplasmosis often presents with a dominant nodule and surrounding satellite granulomas, typically distributed along lymphatics and vessels. These lesions, along with hilar lymphadenopathy, characteristically undergo progressive calcification over time, which can take several years. The presence of a pulmonary infarct and pleural effusion is an unusual concomitant finding not typical of isolated histoplasmosis. Urinary antigens are a common method for diagnosis.
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