A RARE CASE OF EXTRA-PULMONARY ANTHRACOSIS

TOPIC: Occupational and Environmental Lung Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: We present a unique case of anthracosis, common in coal workers, which caused FDG-PET/CT positive mediastinal lymphadenopathy. The majority cases are associated with malignancy, infectious processes, granulomatous disease, benign conditions [1]. exact prevalence this disease is difficult to estimate because many people anthracosis asymptomatic, hence, discovered incidentally [2]. Endobronchial ultrasonography (EBUS) transbronchial needle aspiration (TBNA), has been an important method frequently used both the diagnosis staging lesions suspected malignancy initial investigation [3]. CASE PRESENTATION: 80-year-old male who was referred pulmonary clinic after incidental finding lung nodule. patient reported no symptoms at time visit. Past medical history insignificant. Social pertinent for 55 pack-year smoking last use one year before presentation. retired plumbing excavator. There known tuberculosis. Physical examination unremarkable. Quantiferon testing indeterminate, angiotensin-converting enzyme (ACE) test fungal serum markers were negative. A recent CT chest without contrast identified left nodule lymph nodes. Follow-up FDG-PET scan demonstrated small mildly enlarged hypermetabolic right lower paratracheal node measured 1.6 x 1.1 cm had SUV ranging from 7.8-10.7. EBUS guided biopsy showed found carbon-containing histiocytic aggregates malignant cells on cytopathology nodes, 4L, 4R. DISCUSSION: Extra-pulmonary rare that requires accurate lymph-node sampling establish diagnosis. It's commonly due inhalation dust, smoke, or pollution [4]. Our not all elevated bronchoscopy didn't show any anthracotic pigmentation narrowing airways [5]. CONCLUSIONS: highlight importance complete workup nodules routine imaging. Based absence malignant, granulomatous, processes presence aggregates, we confidently diagnosed extra-pulmonary anthracosis. REFERENCE #1: Hewitt RJ, Wright C, Adeboyeku D, Ornadel Berry M, Wickremasinghe A, Sykes Kon OM. Primary nodal by EBUS-TBNA as cause FDG PET/CT Respir Med Rep. 2013 Sep 27;10:48-52. Doi: 10.1016/j.rmcr.2013.09.005. PMID: 26029513; PMCID: PMC3920429. DISCLOSURES: No relevant relationships Rabia Anees, source=Web Response Rosa Arancibia, Andrew Doodnauth, Khawaja Omar,