Volume 144, Issue 1, Pages 323-327 (July 2013) A Case of Hut Lung  Sanjay Mukhopadhyay, MD, Manmeet Gujral, MD, Jerrold L. Abraham, MD, Ernest M. Scalzetti, MD, Michael C. Iannuzzi, MD, FCCP  CHEST  Volume 144, Issue 1, Pages 323-327 (July 2013) DOI: 10.1378/chest.12-2085 Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 1 A, Axial and coronal lung images from the first CT scan. The axial high-resolution image shows a typical ground-glass nodule in the upper lobe of the right lung (white arrow). The coronal section is a thin-slab maximum-intensity projection showing additional such nodules elsewhere in the right upper lobe (black arrows). B, Axial high-resolution images from the second CT scan. Multiple ground-glass nodules are visible in the right upper lobe and near the major fissure in the left upper lobe, on the upper image. A relatively large ground-glass nodule is apparent in the right lower lobe, in the posterior basal segment, on the lower image. CHEST 2013 144, 323-327DOI: (10.1378/chest.12-2085) Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 2 Image from second CT scan, showing mild enlargement of left hilar lymph node (arrow) and subcarinal lymph node (arrowhead). CHEST 2013 144, 323-327DOI: (10.1378/chest.12-2085) Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 3 A, BAL cytology showing several macrophages filled with coarse black dust (Papanicolaou stain, ×400). B, Transbronchial biopsy, low magnification (Papanicolaou stain, ×40). There is heavy deposition of black pigment within the pulmonary interstitium, including alveolar septa and peribronchial interstitium. There is mild interstitial fibrosis. This is, therefore, a mixed-dust fibrotic lesion. Similar lesions without significant fibrosis (macules) were also present. The combination of mixed-dust fibrosis lesions and macules is typical of mixed-dust pneumoconiosis. C, Dust-filled macrophages in transbronchial biopsy, high magnification (Papanicolaou stain, ×400). D, Same area as C, viewed under polarized light, showing that although the black dust is not birefringent, small numbers of other particles are weakly birefringent (silica) or strongly birefringent (silicates). CHEST 2013 144, 323-327DOI: (10.1378/chest.12-2085) Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 4 Scanning electron microscopy (SEM) with energy-dispersive x-ray spectroscopy (EDS) images (scale bars in micrometers). A, SEM image of a dusty area. B, Higher magnification shows a macrophage (arrow) containing innumerable particles. C, Individual particles visualized in macrophage. D, EDS spectra of a silica particle. E, EDS spectra of an aluminum silicate particle. CHEST 2013 144, 323-327DOI: (10.1378/chest.12-2085) Copyright © 2013 The American College of Chest Physicians Terms and Conditions