BACKGROUND & AIMS: Mediastinal granulomas due to histoplasmosis can cause dysphagia and can be difficult to diagnose. The aim of this study was to describe the endoscopic ultrasonography (EUS) findings of suspected mediastinal granulomas. METHODS: Eleven patients with dysphagia were referred for EUS because endoscopy showed a midesophageal submucosal mass or stricture. RESULTS: All patients had similar EUS findings of a large mass of matted, posterior mediastinal lymph nodes that were adherent to a focally thickened esophageal wall. The cause of the mediastinal granulomas was believed to be histoplasmosis because 3 of the patients had positive complement fixation titers of 1:32, 1 of whom had a surgical resection showing a caseating granuloma. The diagnosis of histoplasmosis mediastinal granulomas was also supported by the findings of lymph node calcification on EUS in 7 patients, the presence or development of midesophageal traction diverticula in 5 patients, and clinical improvement after oral antifungal drug therapy in 7 patients. No patient developed evidence of malignancy during a mean follow-up period of 20.5 months. CONCLUSIONS: Based on characteristic EUS findings, mediastinal granulomas are believed to occur in patients with dysphagia who have a midesophageal submucosal mass or stricture on endoscopy and who live in a highly endemic area for histoplasmosis.
BACKGROUND & AIMS:Mediastinal granulomas due to histoplasmosis can cause dysphagia and can be difficult to diagnose. The aim of this study was to describe the endoscopic ultrasonography (EUS) findings of suspected mediastinal granulomas. METHODS: Eleven patients with dysphagia were referred for EUS because endoscopy showed a midesophageal submucosal mass or stricture. RESULTS: All patients had similar EUS findings of a large mass of matted, posterior mediastinal lymph nodes that were adherent to a focally thickened esophageal wall. The cause of the mediastinal granulomas was believed to be histoplasmosis because 3 of the patients had positive complement fixation titers of 1:32, 1 of whom had a surgical resection showing a caseating granuloma. The diagnosis of histoplasmosis mediastinal granulomas was also supported by the findings of lymph node calcification on EUS in 7 patients, the presence or development of midesophageal traction diverticula in 5 patients, and clinical improvement after oral antifungal drug therapy in 7 patients. No patient developed evidence of malignancy during a mean follow-up period of 20.5 months. CONCLUSIONS: Based on characteristic EUS findings, mediastinal granulomas are believed to occur in patients with dysphagia who have a midesophageal submucosal mass or stricture on endoscopy and who live in a highly endemic area for histoplasmosis.
Authors: Hae Jung Song; Jin-Oh Kim; Soo Hoon Eun; Young Deok Cho; In Seop Jung; Young Koog Cheon; Jong Ho Moon; Joon Seong Lee; Moon Sung Lee; Chan Sup Shim; Boo Sung Kim; So Young Jin Journal: Gut Liver Date: 2007-06-30 Impact factor: 4.519
Authors: D B Williams; A V Sahai; L Aabakken; I D Penman; A van Velse; J Webb; M Wilson; B J Hoffman; R H Hawes Journal: Gut Date: 1999-05 Impact factor: 23.059