Mediastinal fibrosis complicating histoplasmosis.

Mediastinal fibrosis, the most serious late complication of remote infection by Histoplasma capsulatum, is a thick, dense fibrotic capsule which surrounds a small mediastinal focus of old caseous adenitis. The fibrotic process may accrue over prolonged periods and extend within the lumina of critical mediastinal structures to produce complete occlusion. We summarized clinical and radiographic data for 71 patients with mediastinal fibrosis; the criteria for inclusion were the clinical demonstration of occlusion of major central airways (trachea or mainstem bronchus) or major vessels (pulmonary arteries or veins) and the absence of other disease processes which might cause such obstruction.

Histoplasmoma, pleural fibrosis, and slowly enlarging pleural effusion in an asymptomatic patient.

A slowly enlarging pleural effusion and significant pleural fibrosis occurred in an asymptomatic patient with a subpleural histoplasmoma. The pleural disease may be a reaction to antigen diffusing into the pleural space from the histoplasmoma. In selected patients, resection of the histoplasmoma may be necessary to prevent impairment of ventilation from pleural fibrosis.

Surgical intervention in histoplasmosis.

Histoplasmosis is a ubiquitous disease in endemic areas that has a generally subclinical course. Excessive inflammatory response may bring some patients to the attention of a thoracic surgeon to exclude malignancy of a noncalcified pulmonary or mediastinal mass or to relieve compression of specific structures. Mediastinal granuloma or fibrosing mediastinitis may involve the superior vena cava, pulmonary vessels, heart and pericardium, tracheobronchial tree, or esophagus.

Atypical Histoplasma capsulatum infection in a dog.

Disseminated histoplasmosis was diagnosed in a 10-year-old dog suspected of having hepatic carcinoma. Clinical abnormalities included diffuse hepatomegaly, gastrointestinal bleeding, thoracic and abdominal effusion, anemia, leukocytosis, and thrombocytopenia. Histoplasmosis characteristically is a disease of the mononuclear phagocyte system, but in this case was diagnosed by finding Histoplasma capsulatum organisms in neutrophils on the blood smear.

Esophageal obstruction caused by mediastinal histoplasmosis: beneficial results of operation.

A patient presented with progressive dysphagia and chest pain. Radiologic investigation showed extrinsic compression of the esophagus by enlarged, calcified, mediastinal lymph nodes. Immunologic studies suggested that this was due to previous histoplasmosis, currently inactive.

Late development of mediastinal calcification in sarcoidosis.

Calcification of mediastinal lymph nodes developed in more than 20% of 111 patients with sarcoidosis followed for 10 yr or more. Lymph node calcification appeared in most instances during the second or third decade after the onset of the disease, chiefly in patients who had both mediastinal adenopathy and pulmonary infiltrates. Pre-existent calcification attributable to tuberculosis or histoplasmosis was noted in less than 3% of patients.

Intraoperative fine needle aspiration biopsy of thoracic lesions.

Forty-one intraoperative fine needle aspiration biopsies were performed on 35 patients during exploratory thoracotomy (33 patients) or mediastinoscopy (2 patients). Each biopsy was done with a 22 gauge needle. Smears were prepared at the operating table, air-dried, sent directly to the laboratory, stained, and interpreted immediately by the pathologist.

The multiple roentgen manifestations of sclerosing mediastinitis.

Sclerosing mediastinitis is excessive production of fibrous tissue in the mediastinum. Its most common manifestations, widening of the mediastinum and superior vena caval obstruction, are the only roentgenographic findings generally recognized to be associated with this disease. Analysis of 29 cases of sclerosing mediastinitis and review of the literature reveal that compression of mediastinal organs by constricting bands of collagen may cause various roentgen manifestations including bronchial or tracheal obstruction leading to atelectasis or obstructive pneumonitis, pulmonary venous obstruction, pulmonary artery obstruction, esophageal obstruction and nerve entrapment.

Calcification of the heart and great vessels.

Calcification of the heart and great vessels is secondary to those diseases which cause a significant alteration of tissue matrix. Metabolic derangements can cause microscopic calcification of heart muscle, but this has not been demonstrated conclusively roentgenographically. The deposition of calcium may follow a single event or be the result of a longstanding process.

Mediastinal histoplasmosis with abscess.

A mediastinal mass of clinically undetermined nature was found at autopsy to be an enormous abcess due to secondary infection in granulamatous caseating mediastinal nodes caused by Hitosplasma capsulatum. Other complications of mediastinal histoplasmosis are briefly reviewed.

Lymphangiographic findings in histoplasmosis.

The lymphangiographic findings of histoplasmosis in an 11-year-old girl are presented and correlated with the histopathology of a mediastinal lymph node. Nonconfluent lymphadenographic defects with discrete margins measuring 2-4 mm in diameter were seen, corresponding to the microscopic demonstration of nodal granulomas of the same size. This is quite different from the lymphadenographic pattern usually present in lymphoma but might be seen in certain stages of other granulomatosis diseases.

Histoplasmosis. A review, and account of three patients diagnosed in Great Britain.

Active histoplasmosis is rarely diagnosed in Great Britain. We present the illness records of three patients with disseminated histoplasmosis. In two patients the infection was discovered at necropsy and resulted in caseous destruction of the adrenal glands, and in one of these there was also fungal invasion of the liver and wall of the aorta.