Histoplasma capsulatum is a fungus that is endemic in many parts of the world and can present with a wide variety of symptoms. Here we present a case of a previously healthy 19-year-old female who presented with shortness of breath. She was found to have a right lung mass and coarctation of the aorta on computed tomography imaging. Pathology revealed granuloma caused by Histoplasma capsulatum. She later developed massive pericardial effusion, requiring emergent pericardiocentesis. She was treated with anti-fungal therapy and recovered well. This case illustrates an unusual presentation of newly diagnosed coarctation of the aorta complicated by Histoplasma pericardial effusion. Imaging and pathology slides are reviewed.