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Summary
CT imaging demonstrates bulky high-attenuation hilar and mediastinal lymphadenopathy which may produce bronchial and vascular narrowing. Large rapidly-progressive pleural effusions are characteristic. The portal of entry is the airway and the organisms are rapidly transmitted via the lymphatics to the intrathoracic lymph nodes and ultimately to the blood stream. Despite the inhalational acquisition of the disease, the lung parenchyma remains relatively uninvolved.