Pulmonary hyalinising granuloma
Pulmonary hyalinising granuloma (PHG) is a rare, non-infectious, benign fibrosing lesion of the lung. It can sometimes mimic pulmonary malignancy.
Most patients (~ 75% 6) with pulmonary hyalinising granulomas can be symptomatic with it. Commonly reported symptoms include vague chest-related symptoms such as shortness of breath; cough; fatigue; low-grade fever; pleuritic chest pain; or rarely, haemoptysis. Up to 25% of patients are symptom free.
Histological features can bear a striking resemblance to fibrosing mediastinitis 1. The center of the lesion consists of hyaline collagen arranged in a distinctive pattern of concentric lamellae sometimes with focal calcification or ossification.
Their exact aetiology is not well known, but they may be caused by an exaggerated immune response.
They are probably related to a chronic immune reaction to either endogenous or exogenous antigens or infectious agents such as H. capsulatum or Mycobacterium organisms. They are thought to occur in individuals predisposed to marked scar formation.
Plain film - chest radiograph
They may be seen as slow growing solitary or, more often, multiple well defined nodules on radiographs 1.
Pulmonary hyalinizing granulomas can appear as well-marginated solitary or multiple nodules varying from a few millimeters to 15 cm in size. There may be associated calcification which is usually focal central and irregular 6.
History and etymology
It was first described by P Engleman et.al in 1977 5.
- 1. Chalaoui J, Grégoire P, Sylvestre J et-al. Pulmonary hyalinizing granuloma: a cause of pulmonary nodules. Radiology. 1984;152 (1): 23-6. Radiology (abstract) - Pubmed citation
- 2. Khan AN, Al-Jahdali HH, Allen CM et-al. The calcified lung nodule: What does it mean?. Ann Thorac Med. 2010;5 (2): 67-79. doi:10.4103/1817-1737.62469 - Free text at pubmed - Pubmed citation
- 3. Winger DI, Spiegler P, Trow TK et-al. Radiology-Pathology Conference: pulmonary hyalinizing granuloma associated with lupus-like anticoagulant and Morvan's Syndrome. Clin Imaging. 2007;31 (4): 264-8. doi:10.1016/j.clinimag.2007.03.007 - Pubmed citation
- 4. Basoglu A, Findik S, Celik B et-al. Pulmonary hyalinizing granuloma mimicking lung carcinoma. Thorac Cardiovasc Surg. 2006;54 (4): 282-3. doi:10.1055/s-2006-923799 - Pubmed citation
- 5. Engleman P, Liebow AA, Gmelich J et-al. Pulmonary hyalinizing granuloma. Am. Rev. Respir. Dis. 1981;115 (6): 997-1008. Pubmed citation
- 6. Colen RR, Nagle JA, Wittram C. Radiologic-pathologic conference of the Massachusetts General Hospital. Pulmonary hyalinizing granuloma. AJR Am J Roentgenol. 2007;188 (1): W15-6. doi:10.2214/AJR.06.0380 - Pubmed citation
- 7. Russell AF, Suggit RI, Kazzi JC. Pulmonary hyalinising granuloma: a case report and literature review. Pathology. 2001;32 (4): 290-3. Pubmed citation
- 8. Marchiori E, Souza AS, Franquet T et-al. Diffuse high-attenuation pulmonary abnormalities: a pattern-oriented diagnostic approach on high-resolution CT. AJR Am J Roentgenol. 2005;184 (1): 273-82. doi:10.2214/ajr.184.1.01840273 - Pubmed citation