Faces of Granulomatous Diseases

Infection Inflammation Malignancy Mechanical/Atelectasis Trauma Metabolic Circulatory- Hemorrhage Immune Infiltrative Idiopathic Iatrogenic Idiopathic

CT Acute Miliary Pulmonary Histoplasmosis
Centrilobular and Peril-ymphatic Distribution

CT Acute Miliary Pulmonary Histoplasmosis
22-year-old female presents with flu like symptoms
CT of the chest at the level of the main pulmonary artery shows extensive diffuse miliary disease. Some of the nodules are centrilobular (yellow arrowheads). Some of the secondary lobules suggest mosaic attenuation (black arrowhead). The nodular and irregular appearance on the fissure (white arrowhead) indicates peri-lymphatic distribution.
Ashley Davidoff MD TheCommonvein.net 131708cL

  • INFECTIONS

    • Mycobacterial Infections
      • Tuberculosis MtB
      • Non Tuberculous Mycobacterial Infection NTM
        • MAC
          • M intracellulare and
          • M avium
        • M kansasii, M fortuitum, M chelonae, M abscesus, M gordonae, M xenopi,
    • Other Bacteria
      • Brucella spp,
      • Actinomyces spp,
      • Francisella tularensis,
      • Bartonella henselae,
      • Nocardia spp
      • Yersnia enterocolitica,
      •  Listeria monocytogenes,
      • Burkholderia pseudomallei (melioidosis),
      • Coxiella burnetti,
    • Fungal Infections
      • Histoplasma,
      • Cryptococcus,
      • Blastomyces,
      • Coccidioides,
      • Paracoccidioides,
      • Candida and
      • Aspergillus
    • Parasitic
      •  Dirofilaria immitis (dog heartworm), a
      • Ova of Schistosoma spp and
      • Paragonimus westermanii.

 

  • Inflammatory

    • Sarcoidosis
    • Hypersensitivity Diseases

      • HP

      •  triad of
        cellular bronchiolitis
        interstitial pneumonitis, , and
        poorly formed granulomas is seen in
        80% of well-documented cases of SHP.73 

        • Bronchiolitis Bronchiolectasis,
          • granulomas, and fibrosis of bronchiolar walls
          • accentuated around small airway
          • chronic interstitial inflammation
        • Alveoli and Interstium
          • granulomas
          • Foci of OP
          • oblirterative bronchioloitis

      • Berylliosis

  • Vasculitic Granulomatous Diseases

    • Granulomatosis With Polyangiitis Wegeners)

      • granulomatous inflammation,
      • necrosis, and
      • vasculitis accompanied
      • Organizing pneumonia is a frequent finding and
      • may be the predominating finding in biopsy specimens.
    • vasculitis
      • may involve arteries,
      • veins
      • capillaries
  • Eosinophilic Granulomatosis With Polyangiitis (Churg Strauss)
    • small-vessel ANCA-associated vasculitides

Links and References

Rosen, Y Arch Pathol Lab Med (2022) 146 (2): 233–251.