Coleman Christopher, Nassar Aziza, McComb Barbara
Department of Diagnostic Radiology, Mayo Clinic, Jacksonville, FL 32224, USA.
Department of Pathology, Mayo Clinic, Jacksonville, FL 32224, USA.
J Clin Imaging Sci. 2014 Feb 25;4:8. doi: 10.4103/2156-7514.127835. eCollection 2014.
Pulmonary hyalinizing granuloma (PHG) is a rare, benign lung disease of unknown etiology. It manifests as discrete, rounded nodules within the lung parenchyma. A 39-year-old woman presented for investigation after pulmonary nodules were found incidentally. Chest computed tomography showed multiple, discrete, non-enhancing pulmonary nodules bilaterally. Positron emission tomography (PET) was negative. Biopsy demonstrated a non-specific lymphoplasmacytic infiltrate. Open resection yielded two nodules consistent with hyalinizing granulomas. The differential for multiple pulmonary nodules is broad. PET scan can help rule out metastatic disease, although some cancers are not hypermetabolic on PET. Furthermore, some non-malignant conditions, including hyalinizing granuloma, can show increased activity on PET. PHG should be included in the differential of multiple pulmonary nodules, especially if nodule stability can be demonstrated and/or needle biopsies are non-diagnostic. Associated immune-mediated conditions, such as idiopathic thrombocytopenic purpura (ITP) in our patient, may also favor HG. In this case report we find an association between PHG and ITP.
肺透明变性肉芽肿（PHG）是一种病因不明的罕见良性肺部疾病。它表现为肺实质内离散的圆形结节。一名39岁女性在偶然发现肺部结节后前来接受检查。胸部计算机断层扫描显示双侧有多个离散的、无强化的肺结节。正电子发射断层扫描（PET）结果为阴性。活检显示为非特异性淋巴浆细胞浸润。手术切除得到两个符合透明变性肉芽肿的结节。多个肺结节的鉴别诊断范围很广。PET扫描有助于排除转移性疾病，尽管有些癌症在PET上并非高代谢。此外，一些非恶性疾病，包括透明变性肉芽肿，在PET上也可能显示活性增加。PHG应列入多个肺结节的鉴别诊断中，特别是如果能证明结节稳定和/或穿刺活检无法确诊。相关的免疫介导疾病，如我们患者的特发性血小板减少性紫癜（ITP），也可能支持诊断为HG。在本病例报告中，我们发现PHG与ITP之间存在关联。
