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Histoplasmomas of Uncommon SizeHistoplasmomas of Uncommon Size

Bradley W. Richmond, MD; John A. Worrell, MD; Julie A. Bastarache, MD; Daniel H. Gervich, MD; Wendolyn R. Slattery, MD; James E. Loyd, MD
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From the Division of Allergy, Pulmonary, and Critical Care Medicine (Drs Richmond, Bastarache, and Loyd) and the Department of Radiology (Dr Worrell), Vanderbilt University School of Medicine, Nashville, TN; CIC Associates (Dr Gervich), Mercy Medical Center, Des Moines, IA; and Mercy Hospital (Dr Slattery), Allina Hospitals and Clinics, Coon Rapids, MN.

Correspondence to: Bradley W. Richmond, MD, Vanderbilt University Medical Center, Division of Allergy, Pulmonary, and Critical Care Medicine, B1323 Vanderbilt Medical Center North, 1161 21st Ave S, Nashville, TN 37232; e-mail: bradley.richmond@vanderbilt.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1795-1798. doi:10.1378/chest.12-2071
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Histoplasma capsulatum infection demonstrates a broad spectrum of acute and chronic clinical manifestations. Unlike the acute reaction to proliferating organisms, the chronic complications are often the result of excessive or prolonged host response with a paucity of organisms. Lung nodules (histoplasmomas) may be noted decades after initial infection and present a challenging clinical problem, as they can be difficult to distinguish from malignancy or tuberculomas. Typically, histoplasmomas are small (<1 cm), asymptomatic, and may be stable in size or slowly enlarge over time. Here we report three patients with unusually large, or giant, histoplasmomas (>3 cm) and describe their extreme phenotype. Importantly, two of the patients presented with subacute symptomatic disease, a presentation that is very atypical for histoplasmoma. The term “buckshot” calcification has been used to describe dozens of small (2-4 mm) calcified nodules, so it may be appropriate to label masses that exceed 3 cm as “cannonball” histoplasmoma.

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