Differential Diagnosis for Small Calcified Granuloma Asymptomatic CXR

• Single most likely diagnosis
  • Histoplasmosis: This is a common cause of small calcified granulomas, especially in endemic areas. The calcification is usually a result of healed histoplasmosis infection.
• Other Likely diagnoses
  • Tuberculosis (TB): Healed TB can also present as small calcified granulomas on chest X-ray (CXR). The calcification represents a healed focus of infection.
  • Sarcoidosis: While sarcoidosis can cause a variety of findings on CXR, including granulomas, calcification is less common but can occur, especially in chronic cases.
  • Silicosis: This occupational lung disease can lead to calcified granulomas, particularly in individuals with a history of silica dust exposure.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Malignancy (e.g., calcified metastasis): Although rare, some malignancies can present with calcified lesions. Missing a diagnosis of malignancy could have severe consequences.
  • Fungal infections other than histoplasmosis (e.g., coccidioidomycosis): These can also cause calcified granulomas and, depending on the organism, may require specific treatment.
• Rare diagnoses
  • Berylliosis: A rare occupational disease that can cause granulomatous disease similar to sarcoidosis, with potential for calcification.
  • Parasitic infections (e.g., dirofilariasis): These can occasionally cause calcified granulomas, especially in endemic areas or in individuals with a history of travel to such areas.
  • Congenital or developmental anomalies: Rarely, congenital or developmental anomalies can present as calcified lesions on CXR, though these would typically be identified earlier in life.