The Annals of Thoracic Surgery, Vol 30, 385-390, Copyright © 1980 by The Society of Thoracic Surgeons
Pulmonary, mediastinal, and cardiac presentations of histoplasmosis
RL Prager, DP Burney, G Waterhouse and HW Bender Jr
Sixty-one patients with histoplasmosis were identified. They ranged from 14
months to 67 years old. There were 56 male and 5 female patients. Disease
presentations were categorized into pulmonary (47), mediastinal (11),
pericardial (2), and cardiac (1). Twenty of the patients with pulmonary
involvement had histoplasmomas treated by wedge resection (18) or lobectomy
(2). Twenty-two of the 27 cavitary lesions were treated by lobectomy and 4
by segmental resection, and 1 required pneumonectomy. The patients with
mediastinal granulomas or fibrosis underwent exploration for diagnosis and
curative or palliative procedures. Two patients with pericardial
histoplasmosis required pericardial windows to relieve acute tamponade. One
patient with disseminated histoplasmosis required aortic valve replacement
for histoplasmosis valvulitis with severe regurgitation. The 1 operative
death was a patient requiring pneumonectomy for mediastinal histoplasmosis.
Indications for operative intervention in pulmonary histoplasmosis included
resection of a new or enlarging pulmonary nodule to provide a definite
pathological diagnosis and resection of persistent thick-walled pulmonary
cavities. Mediastinal granuloma with or without fibrosis required
exploration for diagnosis, palliation, or cure. Fungal endocarditis
necessitated treatment with amphotericin B and valve replacement to
stabilize the patient's hemodynamic status and prevent embolization of
large fungal vegetations. Pericardial effusion, a rare manifestation of
histoplasmosis, was seen as acute tamponade requiring emergency
intervention.
