Adenopathy and Pulmonary Infiltrates in a Japanese Emigrant in Brazil Alexandre M. Kawassaki, MD, Hironori Haga, MD, Thiago C.A. Dantas, MD, Rafael S. Musolino, MD, Bruno G. Baldi, MD, Carlos R.R. Carvalho, MD, Ronaldo A. Kairalla, MD, Thais Mauad, MD, PhD  CHEST  Volume 139, Issue 4, Pages 947-952 (April 2011) DOI: 10.1378/chest.10-0632 Copyright © 2011 The American College of Chest Physicians Terms and Conditions

Figure 1 A, Chest radiograph showing mediastinal and bilateral hilar enlargement and diffuse linear and nodular opacities in both lung parenchyma. B, PET scan shows increased uptake of 18F-fluordeoxyglucose in the left shoulder and in the cervical, mediastinal, abdominal, and inguinal lymph nodes. C, Chest high-resolution CT scan reveals honeycombing (black arrowheads), nodules (white arrowheads), patchy ground-glass attenuation (white *), and traction bronchioloectasis (arrow). D, Diffuse and symmetric adenopathy (black *). CHEST 2011 139, 947-952DOI: (10.1378/chest.10-0632) Copyright © 2011 The American College of Chest Physicians Terms and Conditions

Figure 2 A, Lymph node showing expansion of interfollicular areas. The inset shows that atypia or multinucleation is not evident in the infiltrating plasma cells (hematoxylin and eosin [H&E] stain, original magnification ×20; inset, ×100). B, Thickening of alveolar septa is seen with dense lymphoplasmacytic infiltration and mild fibrosis (H&E stain, original magnification ×10). C, Part of a lung nodule (0.7 cm in greatest dimension) shows mild phlebitis in the center area (Verhoeff-Masson trichrome stain, original magnification ×2). D, Immunopositivity for IgG4 in the infiltrating plasma cells (Verhoeff-Masson trichrome stain, original magnification ×20). CHEST 2011 139, 947-952DOI: (10.1378/chest.10-0632) Copyright © 2011 The American College of Chest Physicians Terms and Conditions