Abstract Pulmonary hyalinizing granuloma (PHG) is a rare disease hallmarked by multiple bilaterally benign lung nodules. Findings are often incidentally noted on imaging, with mild or asymptomatic presentation. Chest imaging traditionally exhibits widely disseminated pulmonary nodules and mediastinal adenopathy. Histological analysis of such nodules reveal homogenous hyaline lamellae with perivascular cuffing. Patients are often minimally symptomatic on presentation, and its manifestation is thought to be linked to infectious and/or autoimmune etiology. This case report focuses on a case of PHG in a 49 year old male with significant occupational and social exposures, to help us better understand the disease process and clinical presentation. He immigrated from Mexico in the early 2000’s and has been employed in the tile and stone installation business (with appropriate PPE use) for the majority of his adult life. Initially presented to the ED for left upper extremity and head pain status post granite falling onto his back while at work, computed tomography (CT) of the chest revealed incidental findings of bilateral hilar/mediastinal lymphadenopathy and diffuse miliary pattern with patchy consolidations throughout bilateral lung fields (figure 1). Fungal and Infectious studies were unremarkable. Cardiothoracic surgery was consulted and the patient underwent Video-Assisted Thoracic Surgery (VATS). Miliary pattern was found throughout both line and large rubber textured lymph nodes. Wedge biopsy was positive for features consistent with hyalinizing granuloma and anthracosis. Upon outpatient follow up, pulmonary function testing (PFT’s) showed evidence of severe obstruction with no response to bronchodilators. Repeat CT chest 3 months later showed worsening nodular changes. The patient was ultimately recommended for lung transplantation evaluation and continues to follow outpatient with pulmonology. Although the underlying mechanism of PHG is still unclear, previous case reports have displayed an association with autoimmune and infectious processes. Despite the fact that our patient did have significant exposure to stone/marble cutting, his appropriate use of PPE and workup (imaging, histological findings on biopsy) is more consistent with PHG as opposed to other possible differential diagnoses (specifically silicosis). Overall, this rare case report denoting a middle aged male with various environmental/social exposures further exemplifies a likely inflammatory component in the disease process of PHG. As we continue to follow this case, we hope to gain further understanding on the pathophysiology and mechanism of disease of PHG. Figure 1: Computed tomography (CT) chest showing diffuse miliary nodularity, patchy areas of consolidation and left pneumothorax This abstract is funded by: None
Samara et al. (Fri,) studied this question.