• 47 y , electrical engineer, non – smoker

• asymptomatic

• 2007 - cervical TB lymphadenitis. 6 months Rx

• Sept : 2010 : Middle – East pre-employment check

CECT chest

• Multiple bilateral variable sized pulmonary nodules of 10 – 34 mm diameter, largest seen at right base (post. segment), all lesions are solid, showing no calcifications or break down with insignificant CE

Multiple bilateral pul. Nodules. ? granulomatous, ? neoplastic

Pulmonary Hyalinizing Granuloma

• distinct fibrosing lesions of lung, with central whorled deposits of lamellar collagen

• middle aged • > 50 % have some auto-immune process or

previous exposure to mycobacterial or fungal antigen

• usual a benign course but can often cause debilitaiting dyspnoea (sclerosing mediastinitis)