DYSPHAGIA DUE TO MEDIASTINAL GRANULOMAS - DIAGNOSIS WITH ENDOSCOPIC ULTRASONOGRAPHY

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.