title: Histoplasmomas of uncommon size.
abstract: 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 (&lt;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 (&gt;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.
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: bradley.richmond@vanderbilt.edu.
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Richmond
authors.affiliation: Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: John A
authors.initials: JA
authors.lastname: Worrell
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Bastarache
authors.affiliation: CIC Associates, Mercy Medical Center, Des Moines, IA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Gervich
authors.affiliation: Mercy Hospital, Allina Hospitals and Clinics, Coon Rapids, MN.
authors.forename: Wendolyn R
authors.initials: WR
authors.lastname: Slattery
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: James E
authors.initials: JE
authors.lastname: Loyd
mesh_terms: D000293:Adolescent; D002648:Child; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005260:Female; D006660:Histoplasmosis / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged