CTICasesHistoplasmosis Lymphadenitis with Milk of Calcium
Imaging findings
CT in a teenager demonstrates massively enlarged, densely calcified subcarinal and hilar lymph nodes with an appearance suggesting milk-of-calcium calcification. Additional calcified pulmonary granulomas are visible. There is no normal thymus for age.
Key takeaways
Histoplasma capsulatum causes granulomatous mediastinal and hilar lymphadenitis that heals by fibrosis and calcification. In children, calcification can develop within months; in adults it takes longer. The exuberant milk-of-calcium pattern with densely calcified conglomerate mediastinal nodes is distinctive of healed or healing histoplasmosis. The differential includes bronchogenic cyst with milk-of-calcium content, which can also present as a mediastinal mass with milky calcifications.
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