Chest x-rays should be done and may show the following: In acute infection: Normal or a diffuse nodular or miliary pattern In chronic pulmonary histoplasmosis: Cavitary lesions in most patients In progressive disease: Hilar adenopathy with diffuse nodular infiltrates in about 50% of patients Bronchoalveolar lavage or tissue biopsy may be necessary to obtain histology specimens; serologic testing and culture of urine, blood, and sputum specimens are also done.