title: Surgical management of pulmonary and mediastinal sequelae of histoplasmosis: a challenging spectrum.
abstract: BACKGROUND
  Histoplasmosis may result in a spectrum of complications that require thoracic surgical intervention. We reviewed our 17-year experience in the management of histoplasmosis to determine outcomes as well as gain insight into the distribution of complications requiring surgical intervention.
  
  
  METHODS
  The hospital records of patients who underwent surgical treatment for complications related to histoplasmosis from 1991 to 2008 were reviewed. Based on the predominant presentation, patients were categorized with complications secondary to broncholithiasis, granulomatous disease, or fibrosing mediastinitis. Patients who underwent diagnostic surgery and were found to have histoplasmosis were excluded.
  
  
  RESULTS
  Of the 49 patients who underwent surgery for histoplasmosis-related complications, 27 (55%) had granulomatous disease, 13 (27%) had broncholithiasis, and 9 (18%) had fibrosing mediastinitis. The most common clinical presentations were recurrent pneumonia (n = 16) and hemoptysis (n = 13); less common presentations included dysphagia (n = 3) and superior vena cava syndrome (n = 1). Two patients required cardiopulmonary bypass for resection; 1 of these died postoperatively (series mortality 2%). Seven patients (14%) had complications. Relief of symptoms was achieved in all surviving patients.
  
  
  CONCLUSIONS
  Complications of histoplasmosis requiring thoracic surgical intervention are diverse with pulmonary complications predominating. Although surgically challenging, excellent short- and long-term outcomes may be expected.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. zhammou1@hfhs.org
authors.forename: Zane T
authors.initials: ZT
authors.lastname: Hammoud
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Rose
authors.forename: Chadi A
authors.initials: CA
authors.lastname: Hage
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Knox
authors.forename: Karen
authors.initials: K
authors.lastname: Rieger
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Kesler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001982:Bronchial Diseases / Q000601:surgery; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005355:Fibrosis; D006099:Granuloma / Q000601:surgery; D006660:Histoplasmosis / Q000150:complications* / Q000601:surgery*; D006801:Humans; D020347:Lithiasis / Q000601:surgery; D008172:Lung Diseases, Fungal / Q000601:surgery; D008297:Male; D008480:Mediastinitis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures; D055815:Young Adult