Table 4.

Key features of mediastinal histoplasmosis.

Clinical Form
Characteristic	Adenitis	Granulomatous	Fibrosing
Age	Usually < 20 y	All ages > 2 y	Typically 20–30 y
Clinical manifestation	Usually detected during diagnosis of acute pulmonary histoplasmosis. Can have mild obstructive symptoms	Obstructive syndromes (e.g., SVC, dysphagia and chest pain can occur)	Obstructive syndromes (e.g., SVC, pulmonary artery veins, dysphagia, dyspnea)
Pathology	Granulomas	Granulomas with extensive necrosis	Extensive fibrosis with or without granulomas
Radiologic findings	Large nodes, not calcified	Large mass, subcapsular or diffuse calcifications	Proliferative calcified mediastinal nodes with obstruction
Calcifications	None	Usually	Extensive
Indication for treatment	As acute pulmonary	Obstruction or pain	Recurrent hemoptysis, obstruction