PMC8479823_01
Axial CT scan of the chest without constrast demonstrating infiltrative mass with soft tissue window.
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The chest x-ray showed left hilar opacity and chest CT without contrast demonstrated an infiltrative mass in the medial aspect of the upper three quarters of the left hemithorax measuring 11.8cm x 2.6 cm and mediastinal lymphadenopathy (Fig. 1, Fig. 2, Fig. 3, Fig. 4).
Coronal CT scan of the chest without contrast demonstrating the mass.
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The chest x-ray showed left hilar opacity and chest CT without contrast demonstrated an infiltrative mass in the medial aspect of the upper three quarters of the left hemithorax measuring 11.8cm x 2.6 cm and mediastinal lymphadenopathy (Fig. 1, Fig. 2, Fig. 3, Fig. 4).
A photograph taken during the bronchoscopy that showed an endobronchial lesion on right and left main stem bronchi.
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The pathology slide of the subcarinal lymph node (100x) demonstrating granulomas.
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Pathology of both endobronchial lesion and lymph node showed acute and chronic inflammation with granuloma (Fig. 6.) GMS stain of endobronchial tissue highlighted a rare yeast form (Fig. 7), from which the initial impression was histoplasmosis.
The pathology slide of endobronchial lesion (600x) shows a yeast form on GMS special stain.
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Pathology of both endobronchial lesion and lymph node showed acute and chronic inflammation with granuloma (Fig. 6.) GMS stain of endobronchial tissue highlighted a rare yeast form (Fig. 7), from which the initial impression was histoplasmosis.
Axial CT scan of the chest without contrast after treatment showing complete resolution of the mass.
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The patient was treated with itraconazole 200mg twice a day for 12 months with complete resolution of cough, pulmonary infiltrates, and endobronchial lesion (Fig. 8). Fig. 8 shows a repeat CT scan of the Chest without contrast after 1 year of treatment of the blastomycoses that shows complete resolution of the mass.
Photograph from repeat bronchoscopy with resolution of the endobronchial lesion.
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Fig. 9 shows repeat bronchscopy images with resolution of endobronchial mass.