A case of pulmonary mass

53 year old gentleman had chest X ray for as part of some routine workup, which is shown below

The chest X ray showed a calcified well circumscribed mass of about 3 cm in size, as pointed by the arrow.

Differential Diagnosis include

Malignancy which could be primary lung or metastatic

Tuberculosis

Fungal infections

CT chest was ordered and shown below

CT scan confirmed the findings and showed well circumscribed, calcified mass with clear borders and Golf Ball like appearance. 

Biopsy showed spindle shaped cells and yeast forms, confirming the diagnosis of histoplasma. The well circumscribed golf ball like mass is known as histoplasmoma. 

Since this pt was asymptomatic, No treatments interventions were performed

Opacification and Sclerosis of Sphenoid Sinus

Image below shoes thickening and sclerosis of sphenoid sinus wall (as shown by arrow). This shows long standing inflammatory process. Differential include chronic bacterial or fungal sinusitis