An 18-year-old man from Ohio had an abnormality detected on a routine chest radiograph while serving at Guantanamo Bay Naval Base, Cuba, in 1951. At the time of the examination he had no respiratory symptoms, was able to participate in military training and recreational sports, and did not use tobacco. He was transferred to the US Naval Hospital in Portsmouth, Virginia, where it was determined he did not have TB, and he continued military service until 1956. Following discharge he began work as a project engineer at a manufacturing firm. He was again noted to have an abnormal chest radiograph, and because of concern for malignancy he underwent partial resection of the left lower lobe. He was told that he had histoplasmosis, but no treatment was recommended. For the next 3 decades he maintained an active lifestyle and had no respiratory complaints. He moved to Tennessee following retirement in 1995 and began to note dyspnea during exertion. In 1998 he sought medical evaluation, and chest radiography showed calcified mediastinal, bilateral lower lobe, and right middle lobe masses ranging up to 7.7 cm in diameter (Fig 1A). Pulmonary function testing revealed severe obstructive lung disease, with FEV1 of 1.69 L (45% predicted). Bronchoscopy revealed no airway obstruction. Serologic testing for aspergillosis, blastomycosis, coccidiomycosis, and histoplasmosis was negative, as was urine Histoplasma antigen testing. From 2000 to 2007, the FEV1 decreased by 310 mL, but none of the calcified masses increased in size (Fig 1B).