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3. Can be associated with a variety of pulmonary infections

Centrilobular nodules are small nodules that usually do not touch and pleural surface. They have been commonly associated with hypersensitivity pneumonitis but can also be seen in respiratory broncholitis-interstitial lung disease, airway spread of carcinoma, and a variety of infections including bronchopneumonia, tuberculosis or nontuberculous mycobacteria, and Aspergillosis. Sarcoidosis is a common disease but is associated with perilymphatic nodules that touch the pleural surface.

Smears and cultures of sputum are negative for bacteria, fungi and acid-fast bacilli. A decision is made to proceed with a video-assisted thorascopic surgical (VATS) lung biopsy. Representative photomicrographs from the surgical specimens are shown in Figure 3.

Figure 3. Representative photomicrographs from the surgical specimens showing granulomatous inflammation.

Which of the following are true regarding granulomas? (Click on the correct answer to proceed to the fifth and final page)

1. Granulomas are a nonspecific finding that can be seen in a large number of disorders
2. Granulomas are diagnostic of sarcoidosis
3. Granulomas are not associated with Valley Fever
4. Granulomas are uncommon and seen in a few infections such as tuberculosis and some fungal infections
5. Granulomas are usually caused by histoplasmosis and are rarely seen in the Southwest

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