Acute Life-threatening Mediastinal Complications of Histoplasmosis

Evgeny V. Arshava; John Keech; Kalpaj R. Parekh

doi:10.1201/9781315265889-17

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Book chapter

Acute Life-threatening Mediastinal Complications of Histoplasmosis

Evgeny V. Arshava, John Keech and Kalpaj R. Parekh

Thoracic Surgery, pp.91-96

CRC Press, 1

2020

DOI: 10.1201/9781315265889-17

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Abstract

We report a case in which granulomatous mediastinitis caused by histoplasmosis led to life-threatening esophageal-mediastinal fistula with secondary streptococcal mediastinal abscess, purulent pericarditis, and cardiac tamponade. We describe the esophago-bronchial double-transillumination maneuver that can be used to safely drain mediastinal abscesses when the anatomy is distorted. Contrast-enhanced computed tomography showed mediastinal lymphadenopathy and a multiloculated fluid collection with peripheral rim enhancement in the mediastinum, with the largest component measuring up to 4 cm. The purulent multiloculated abscesses with liquid pus around the esophagus, bronchus intermedius, subcarinal space, and distal trachea was drained. A biopsy of chronically inflamed mediastinal lymph nodes returned as necrotizing granulomas with dense fibrosis on frozen section. Acute diffuse pulmonary histoplasmosis may occur after heavy exposure to pathogens during disturbance of heavily contaminated soil or in areas with large amounts of bird or bat feces. Mediastinal granuloma results from progressive granulomatous inflammation, caseous necrosis, and encapsulation of the acutely inflamed mediastinal lymph nodes. The diagnosis of histoplasmosis is made by morphologic examination of granulomas with findings of lymphohistiocytic aggregates and diffuse mononuclear cell infiltrates. Retrospective diagnosis of histoplasmosis can be made as an incidental finding of calcified pulmonary and mediastinal granulomas.

Preoperative CT Scan

Peripheral Rim Enhancement

Mediastinal Abscess

Ventricular Diastolic Collapse

Core Needle Biopsy

Repeat Echocardiogram

Traction Diverticula

GMS Stain

Pneumocystis Jiroveci

Healthy Female Student

Normal White Blood Cell Count

Streptococcus Anginosus

Paraesophageal Hernia

Grocott Gomori’s Methenamine Silver

Histoplasma Capsulatum

Clear Liquid Diet

White Blood Cell

Pulmonary Histoplasmosis

Chest Wall Reconstruction

Bronchus Intermedius

Mediastinal Lymph Nodes

Details

Title: Subtitle: Acute Life-threatening Mediastinal Complications of Histoplasmosis
Creators: Evgeny V. Arshava
John Keech
Kalpaj R. Parekh
Contributors: Wickii T. Vigneswaran (Editor)
Resource Type: Book chapter
Publication Details: Thoracic Surgery, pp.91-96
Edition: 1
Publisher: CRC Press
DOI: 10.1201/9781315265889-17
Alternative title: Acute Life-threatening Mediastinal Complications of Histoplasmosis
Language: English
Date published: 2020
Academic Unit: Cardiothoracic Surgery; Anatomy and Cell Biology
Record Identifier: 9984322775202771

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