Cassandra Campbell, Sandra Arnold, Mario Briceno-Medina, Michael Perez, Shyam Sathanandam
University of Pittsburgh Medical Center. Le Bonheur Children’s Hospital and University of Tennessee Health Science Center. Dell Children’s Medical Center. Nicklaus Children’s Hospital.
United States
Pediatric Cardiology
Pediatr Cardiol 2025;
DOI: 10.1007/s00246-025-04123-w
Abstract
Histoplasmosis in children remains understudied, drawing most clinical understanding from adult populations. Located in a histoplasmosis-hyperendemic region, our institution aimed to characterize the cardiovascular manifestations and interventional treatments in children diagnosed with histoplasmosis. We conducted a retrospective cohort study of 160 patients under 18 years of age diagnosed with histoplasmosis between January 2009 and March 2023 at a tertiary-care children’s hospital. Data reviewed included clinical presentation, imaging, electrocardiograms, echocardiograms, and catheter-based or surgical interventions. Of the 160 patients, 65 (41%) demonstrated cardiovascular involvement from mediastinal manifestations of histoplasmosis (mediastinal lymphadenopathy, mediastinal granuloma, and fibrosing mediastinitis) including all 8 patients with fibrosing mediastinitis. Among these 65 children, pericarditis with pericardial effusion was the most common (58%), 30 patients requiring urgent intervention. Other manifestations from mass effect included pulmonary artery stenosis (34%), superior vena cava (SVC) stenosis (15%), pulmonary vein stenosis (8%), inferior vena cava (IVC) stenosis (3%), and aortic arch obstruction (2%). Fourteen patients underwent catheter-based stenting procedures with a total of 22 stents placed (17 in pulmonary artery branches, 4 in pulmonary veins, and 1 in the SVC), typically not performed during the initial presentation. Five patients underwent mass resection for cardiac indications. Cardiovascular complications from histoplasmosis-related mediastinal lymphadenopathy in children are significant, presenting with pericarditis or compression of central vascular structures. Fibrosing mediastinitis was consistently associated with cardiac involvement, frequently necessitating intervention. Surgical repair is challenging due to extensive fibrosis. However, percutaneous vascular interventions are feasible and effective in managing vascular obstructions. Early recognition and timely intervention are critical to prevent irreversible vascular atresia.
Category
Segmental Pulmonary Venous Disease. Without a Focus on Pulmonary Hypertension
Environmental Factors Associated with Pulmonary Vascular Disease
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes