Pulmonary granulomas: give it a whorl.

A 60-year-old woman with systemic lupus erythematosus, diabetes mellitus and chronic kidney disease presented to the respiratory clinic for shortness of breath on exertion for 6 months and an abnormal routine chest radiography obtained 1 year earlier. She did not have cough, sputum or chest pain. On examination, she was alert and oriented without distress. Auscultation revealed bilateral expiratory wheezes and normal heart sounds without murmur. Her oxygenation was 96% while she was breathing ambient air. Chest radiograph (figure 1A) and CT of the chest (figure 1B) showed bilateral, multiple, variable-sized pulmonary nodules and masses. The lesions were round or polygonal in shape, non-enhancing after contrast injection, with right lower lobe predominance (figure 1C). She had been told that a routine chest radiography 1 year earlier showed multiple pulmonary nodules. Pulmonary function test revealed moderate obstructive ventilator defect with …