65 yo F with PMHx of HTN, HLD, T2DM, OSA, hypothyroidism, cataracts/glaucoma, and depression who presents to ILD clinic for evaluation of pulmonary nodules.
Recent history to note:
5 years ago
New cough in for which she had a CXR showing multiple nodular opacities in the R hemithorax. Subsequent CT chest showed innumerable bilateral pulmonary nodules ranging between 4-8 mm many of which were bronchocentric Noted mediastinal LAD.
PET/CT showed that most of the nodules demonstrated low level FDG avidity though there was an intense FDG uptake of the pleural-based opacity of the medial segment of the RLL. Subsequent surgical lung biopsy showed focal fibrosis and foreign body giant cell reaction, no evidence of malignancy.
65 F presents 6 years ago with both solid nodules and bronchocentric nodules The solid nodule in the right upper lobe (red arrow) grew 6 years later and was biopsied Note the bronchocentric thickening Subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Bronchocentric Nodule Left Upper Lobe
Bronchocentric Nodule Left Upper Lobe 65 F presents 6 years ago with both solid nodules and bronchocentric nodules Ashley Davidoff MD TheCommonVein.net
Bronchocentric Nodules and Suggestion of Micronodules
Bronchocentric Nodule Left Upper Lobe and Suggestion of Micronodules 65 F presents 6 years ago with both solid nodules and bronchocentric nodules Ashley Davidoff MD TheCommonVein.net
Bronchocentric Nodule Right Upper Lobe and Suggestion of Micronodules 65 F presents 6 years ago with both solid nodules and bronchocentric nodules Ashley Davidoff MD TheCommonVein.net
Solid Nodules
Solid Nodules 65 F presents 6 years ago with both solid nodules and bronchocentric nodules This nodule is solid Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Solid Nodules 65 F presents 6 years ago with both solid nodules and bronchocentric nodules This nodule is solid Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
65 F presents 6 years ago with both solid nodules and bronchocentric nodules There is a larger nodule sis conglomerate nodule around the left lower lobe segmental airways Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Wedge Shaped Defects Along the Broncho-vascular Bundle
Sub segmental wedge Shaped Infiltrate Along the Bronchovascular Bundle Raising the Possibility of a Vasculitis 65 F presents 6 years ago with both solid nodules and bronchocentric nodules There is a larger nodule sis conglomerate nodule around the left lower lobe segmental airways Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Subsegmental wedge Shaped Infiltrate Along the Bronchovascular Bundle Raising the Possibility of a Vasculitis 65 F presents 6 years ago with both solid nodules and bronchocentric nodules There is a larger nodule sis conglomerate nodule around the left lower lobe segmental airways Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Subsegmental wedge Shaped Infiltrate Along the Bronchovascular Bundle Raising the Possibility of a Vasculitis 65 F presents 6 years ago with both solid nodules and bronchocentric nodules There is a larger nodule sis conglomerate nodule around the left lower lobe segmental airways Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Subsegmental wedge Shaped Infiltrate Along the Bronchovascular Bundle Raising the Possibility of a Vasculitis 65 F presents 6 years ago with both solid nodules and bronchocentric nodules There is a larger nodule sis conglomerate nodule around the left lower lobe segmental airways Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Subsegmental wedge Shaped Infiltrate Along the Bronchovascular Bundle Raising the Possibility of a Vasculitis 65 F presents 6 years ago with both solid nodules and bronchocentric nodules There is a larger nodule sis conglomerate nodule around the left lower lobe segmental airways Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Solid Nodules Along the Small Vessels of the Bronchovascular Bundle in the Left Lower Lobe
Solid Nodules Along the Small Vessels of the Bronchovascular Bundle in the Left Lower Lobe 65 F presents 6 years ago with both solid nodules and bronchocentric nodules This nodule is solid Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Solid Noudules Along the Small Vessels of the Bronchovascular Bundle in the Left Lower Lobe 65 F presents 6 years ago with both solid nodules and bronchocentric nodules This nodule is solid Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Small Calcified Lymph Nodes in the Mediastinum and Left Hilum 65 F presents 6 years ago with both solid nodules and bronchocentric nodules There is a larger nodule sis conglomerate nodule around the left lower lobe segmental airways Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
Nephrolithiasis 65 F presents 6 years ago with both solid nodules and bronchocentric nodules There is a larger nodule sis conglomerate nodule around the left lower lobe segmental airways Nodules showed waxing and waning and subsequent biopsy showed necrotizing-granuloma Ashley Davidoff MD TheCommonVein.net
4 years ago
Surveillance imaging from showed stable scattered solid spiculated and GG nodules measuring up to 6 mm decreased from 6 years ago
2 years ago she reported having weight loss to her PCP prompting her to check CT chest. P
CT 1 yearago
showed interval growth of a 1.5 cm spiculated RUL nodule (previously measured 6 x 5 mm in 4 years prior) which was FDG-avid on subsequent PET/CT
concerning for malignancy. She was sent for IR biopsy (1 year ago ) which showed necrotizing granuloma without culture growth and no evidence of malignancy.
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