PMC3988602_01
39-year-old woman with pulmonary nodules discovered incidentally diagnosed as pulmonary hyalinizing granuloma associated with idiopathic thrombocytopenic purpura. Lung windows from computed tomography of the abdomen and pelvis demonstrate nodules in the left (red arrow) and right (yellow arrow) lower lobes.
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F1
The present case report is about a 39-year-old woman who presented with pulmonary nodules incidentally detected on abdominal computed tomography (CT) performed for renal calculi [Figure 1].
39-year-old woman with pulmonary nodules discovered incidentally diagnosed as pulmonary hyalinizing granuloma associated with idiopathic thrombocytopenic purpura. (a) Posteroanterior (PA) and b) lateral radiographs demonstrate multiple pulmonary nodules (several of which are identified by arrows) bilaterally with relative peripheral and lower lung zone predominance.
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F2
A chest radiograph demonstrated bilateral rounded pulmonary opacities of various sizes [Figure 2].
39-year-old woman with pulmonary nodules discovered incidentally diagnosed as pulmonary hyalinizing granuloma associated with idiopathic thrombocytopenic purpura. Follow-up computed tomography chest on lung window demonstrates stability of one of the larger nodules in the left lower lobe (red arrow). Additional nodules (yellow arrows) are seen at slightly different levels than on prior study due to differences in positioning and level of inspiration.
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F3
A contrast enhanced chest CT showed multiple rounded, discrete pulmonary nodules bilaterally with relative lower lobe and peripheral predominance, which is a common presentation for metastases [Figure 3].
39-year-old woman with pulmonary nodules discovered incidentally diagnosed as pulmonary hyalinizing granuloma associated with idiopathic thrombocytopenic purpura. Fused images from F-18 fluorodeoxyglucose positron emission tomography- computed tomography demonstrate the index lesion without abnormally increased glucose metabolism.
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F4
CT scan was negative [Figure 4]. CT-guided left lower lobe nodule biopsy yielded non-specific lymphoplasmacytic infiltrate, areas of fresh alveolar hemorrhage and no evidence of well-formed granuloma or malignancy.
39-year-old woman with pulmonary nodules discovered incidentally diagnosed as pulmonary hyalinizing granuloma (PHG) associated with idiopathic thrombocytopenic purpura. a) x10 magnified H and E, stained microscopy of the two nodules from wedge resection (long arrows) shows clusters of lymphoplasmacytic infiltrate (short arrows) peripherally. b) x20 magnified view demonstrates whirled layers of collagen (dark pink) around small blood vessels (*), consistent with PHG. No multinucleated giant cells are present.
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F5
Microscopic analysis of each of the two resected round, well-circumscribed, indurated, tan nodules demonstrated some defining features for hyalinizing granuloma, including layers of collagen concentrically arranged in a whorled fashion around small blood vessels [Figure 5].