Histoplasmosis is the most common endemic respiratory mycosis in the United States. We report the clinical and imaging findings in a case of a child with the rare presentation of a neck abscess and mediastinal lymphadenopathy secondary to acute, non-disseminated histoplasmosis. Imaging findings often mimic other granulomatous infections such as tuberculosis or neoplastic processes such as lymphoma. Histoplasmosis should be considered in the differential diagnosis of a child who presents with enlarged mediastinal and cervical lymphadenopathy.