Waxing and Waning Pulmonary Nodules

• Recurrent aspiration:
• Infection: In immunocompromised hosts (e.g., chronic granulomatous disease).
• Neoplasm: Seminoma metastases, metastatic carcinoma, lymphoma, and lymphomatoid granulomatosis
• Chronic thromboembolic disease: Septic, bland, or neoplastic.
• Hypersensitivity pneumonitis: Most cases follow an insidious course with months or years of exposure. Look for granulomas, centrilobular ground-glass opacities, and air trapping.
• Sarcoid: Look for hilar and mediastinal adenopathy.
• Cryptogenic organizing pneumonia: Peripheral distribution is classic description.
• Rheumatoid arthritis: Cavitary nodules typical. Look at the joints, distal clavicular erosion.
• Churg–Strauss syndrome: Asthma, allergic rhinitis, and peripheral-blood eosinophilia.
• Wegener granulomatosis: Look for cavitary lung nodules and narrowing of the large airways.
• Pulmonary Langerhans cell histiocytosis: Majority are smokers. Affects the middle and upper lung. Nodules usually smaller than 5 mm and associated with thin-walled cysts.
• Simple pulmonary eosinophilia (Loeffler syndrome): Transient and migratory nonsegmental consolidation that typically clears spontaneously within 1 month. Often peripherally located in the middle and upper lung.
• Ehlers–Danlos syndrome:

References

• Fleming CM, Shepard JA, Mark EJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 15-2003. A 47-year-old man with waxing and waning pulmonary nodules five years after treatment for testicular seminoma. N Engl J Med. 2003 May 15;348(20):2019-27.
• Jeong YJ, Kim KI, Seo IJ, Lee CH, Lee KN, Kim KN, Kim JS, Kwon WJ. Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Radiographics. 2007 May-Jun;27(3):617-37; discussion 637-9.