case_images: PMC4737039_01
case_images: Chest X-ray showing right peri-hilar mass with tracheal compression.
case_images: jocmr-08-254-g001.jpg
case_images: PMC4737039_01_jocmr-08-254-g001.jpg
case_images: F1
case_images: Chest X-ray showed a right peri-hilar mass with some tracheal compression (Fig. 1).
case_images: Computed tomography (CT) of chest showing mediastinal mass and mediastinal lymphadenopathy.
case_images: jocmr-08-254-g002.jpg
case_images: PMC4737039_01_jocmr-08-254-g002.jpg
case_images: F2
case_images: 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).
case_images: Wedge resection of right middle lobe of lung showing coalescing fibrocaseous granulomas (hematoxylin-eosin stain, magnification, x 100).
case_images: jocmr-08-254-g003.jpg
case_images: PMC4737039_01_jocmr-08-254-g003.jpg
case_images: F3
case_images: Subsequent endobronchial ultrasound (EBUS) with trans-bronchial needle biopsy of the mediastinal lymph nodes showed coalescing fibrocaseous granulomas with necrosis (Fig. 3, 4).
case_images: Wedge resection of right middle lobe of lung depicting giant cell histiocytes, epithelioid histiocytes, lymphocytes and fibrocaseous necrosis (hematoxylin-eosin stain, magnification, x 100).
case_images: jocmr-08-254-g004.jpg
case_images: PMC4737039_01_jocmr-08-254-g004.jpg
case_images: F4
case_images: Subsequent endobronchial ultrasound (EBUS) with trans-bronchial needle biopsy of the mediastinal lymph nodes showed coalescing fibrocaseous granulomas with necrosis (Fig. 3, 4).
case_images: 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).
case_images: jocmr-08-254-g005.jpg
case_images: PMC4737039_01_jocmr-08-254-g005.jpg
case_images: F5
case_images: Pathologic analysis showed necrotizing granulomas with small fungal yeast that was morphologically most consistent with Histoplasma (Fig. 5).
case_images: Computed tomography (CT) of chest showing pericardial effusion with pericardial thickening.
case_images: jocmr-08-254-g006.jpg
case_images: PMC4737039_01_jocmr-08-254-g006.jpg
case_images: F6
case_images: Repeat CT chest revealed pericardial thickening with massive pericardial effusion (Fig. 6).