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47 y, electrical engineer, non smoker asymptomatic 2007 - cervical TB lymphadenitis. 6 months Rx Sept : 2010 : Middle East pre-employment check Slide 2 Slide 3 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 Slide 4 Slide 5 Slide 6 Slide 7 Slide 8 Slide 9 Slide 10 Slide 11 Slide 12 Slide 13 Slide 14 Slide 15 Slide 16 Slide 17 Slide 18 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)