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Introduction Lymph nodes usually exhibit soft tissue densities in CT with values of 30±50 Hounsfield units HU). Several dis- eases may lead to discrepant HU values. We report a case with increased densities of mediastinal lymph nodes in a patient with long-term aluminum exposure. A 51-year-old adipose man revealed a right-sided persisting pleural effusion and was hospitalized for fur- ther work-up. He had no fever or coughing. The pleural puncture revealed serous fluid 1300 ml) with increased LDH 1032 U/l) and proteins 4.5 g/dl). No malignant cells were found. Computed tomography revealed en- largement of mediastinal lymph nodes and pleural effu- sion. Bronchoscopy was regular. Pleural biopsy revealed discrete inflammatory thickening but no malignancy. Medianoscopy displayed pigment-loaded lymph nodes and chromatographic work-up proved extensive alumi- num storage. The patient worked for 12 years as an aluminum worker using various techniques. An inspection of the occupational surroundings proved the potential possi- bility of significant aluminum-dust exposure. The dust- sucking installation was not permanently used by the patient. Blood gas analysis exhibited slight respiratory partial insufficiency reduced pO 2 ), without impairment of dif- fusion capacity. Pulmonary function showed no obstruc- tive or restrictive ventilatory disturbance. A follow-up spiral CT 8 months later at our institution Philips Tomoscan 7000; collimation 10 mm, table increment 10 mm, reconstruction increment 7 mm) including high-resolution HR) CT 15 sequential 1.5-mm-thick representative sections) revealed non-specific discrete subpleural linear opacities, without evidence for signifi- cant pulmonary fibrosis. Pleural thickening was not visi- ble and a pleural effusion was not present any more. Slight lymph node enlargement was visible within para- aortal, precarinal and infracarinal node groups. All lymph nodes showed increased density on native scans with values of 70±180 HU region-of-interest measure- ment as provided by the vendor; Fig. 1). Lymph nodes usually show soft tissue densities on CT. Diseases of lymph nodes may result in discrepant values typically due to calcifications with values be- yond 200 HU or decreased attenuation. Some diseases may result in increased contrast media uptake Ta- ble 1). Intermediate high-attenuation lymph nodes with val- ues between 50 and 150 HU are not reported in the CT literature in humans Medline literature research 1966±1999). Aluminum pneumoconiosis is considered to be a rare occupational disease that has been reported in alumi- num shavers and polishers and other professionals ex- posed to aluminum-containing dusts [1]. The pulmonary damage consists of fibrotic changes resulting in reticu- lar±nodular opacities on radiological examinations [2]. Progress is gradually developing. Aluminum particles in such patients as well as in ani- mals experimentally exposed to aluminum-containing dust were found in bronchoalveolar lavage, lung tissue, and lymph nodes up to 5 years after stopping the expo- sure [3, 4, 5]. Eur. Radiol. 10, 1945±1946 2000) Ó Springer-Verlag 2000 European Radiology Case report Computed tomographic high-attenuation mediastinal lymph nodes after aluminum exposition M. Vahlensieck 1 , A. Overlack 1 , K.-M. Müller 2 1 Medical Faculty, University of Bonn, 53123 Bonn, Germany 2 Institut für Pathologie, Kliniken Bergmannsheil, 44789 Bochum, Germany Received: 20 January 2000; Revised: 18 May 2000; Accepted: 22 May 2000 Abstract. A case with increased computed tomo- graphic densities of mediastinal lymph nodes with histologically proven aluminum storage is presented. We suggest consideration of aluminosis as differential diagnosis in patients with increased native CT densi- ties beyond 50 HU. Key words: Mediastinal lymph nodes ± CT density ± Aluminosis Correspondence to: M. Vahlensieck Present address: M. Vahlensieck, Wesselheideweg 15, 53123 Bonn, Germany

Computed tomographic high-attenuation mediastinal lymph nodes after aluminum exposition

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