Immune-mediated pericarditis due to histoplasmosis

Left panel: Chest radiograph from a young woman who presented with pulmonary histoplasmosis as evidenced by right paratracheal lymphadenopathy (arrow). The cardiac size was normal and there were no pleural effusions. Right panel: Two weeks later, she experienced dyspnea and now demonstrated a markedly enlarged cardiac silhouette and bilateral pleural effusions. She exhibited signs of pericardial tamponade and underwent percutaneous drainage of the pericardial fluid. Cultures of pericardial fluid were negative.

Posteroanterior view of a normal chest radiograph.