Background and Aims: Mediastinal granulomas due to histoplasmosis can
cause dysphagia and can be difficult to diagnose. The aim of this stud
y was to describe the endoscopic ultrasonography (EUS) findings of sus
pected mediastinal granulomas. Methods: Eleven patients with dysphagia
were referred for EUS because endoscopy showed a midesophageal submuc
osal mass or stricture. Results: All patients had similar EUS findings
of a large mass of matted, posterior mediastinal lymph nodes that wer
e adherent to a focally thickened esophageal wall. The cause of the me
diastinal granulomas was believed to be histoplasmosis because 3 of th
e 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 fin
dings of lymph node calcification on EUS in 7 patients, the presence o
r 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 findin
gs, mediastinal granulomas are believed to occur in patients with dysp
hagia who have a midesophageal submucosal mass or stricture on endosco
py and who live in a highly endemic area for histoplasmosis.