PMC4737039_01
Chest X-ray showing right peri-hilar mass with tracheal compression.
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F1
Chest X-ray showed a right peri-hilar mass with some tracheal compression (Fig. 1).
Computed tomography (CT) of chest showing mediastinal mass and mediastinal lymphadenopathy.
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F2
Computed tomography (CT) scan revealed a 1.2 x 1.1 cm mass in the right hilar region with associated diffuse mediastinal lymphadenopathy (Fig. 2).
Wedge resection of right middle lobe of lung showing coalescing fibrocaseous granulomas (hematoxylin-eosin stain, magnification, x 100).
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F3
Subsequent endobronchial ultrasound (EBUS) with trans-bronchial needle biopsy of the mediastinal lymph nodes showed coalescing fibrocaseous granulomas with necrosis (Fig. 3, 4).
Wedge resection of right middle lobe of lung depicting giant cell histiocytes, epithelioid histiocytes, lymphocytes and fibrocaseous necrosis (hematoxylin-eosin stain, magnification, x 100).
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F4
Subsequent endobronchial ultrasound (EBUS) with trans-bronchial needle biopsy of the mediastinal lymph nodes showed coalescing fibrocaseous granulomas with necrosis (Fig. 3, 4).
Wedge resection of right middle lobe of lung, magnification of fibrocaseous necrosis center of granuloma with budding yeast consistent with histoplasmosis species (Grocott methenamine silver stain, magnification, x 400).
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F5
Pathologic analysis showed necrotizing granulomas with small fungal yeast that was morphologically most consistent with Histoplasma (Fig. 5).
Computed tomography (CT) of chest showing pericardial effusion with pericardial thickening.
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F6
Repeat CT chest revealed pericardial thickening with massive pericardial effusion (Fig. 6).