Mycobacterial fungal must always be considered

chronic beryillium 

• used in making golf clubs

• usually has isolated pulmonary disease

becareful if only one organ involved

usually affects upper 2/3 of the lung (any portion can be affected)

mediastinal LN

CT: shows micronodules coalescing around the airway

right paratrachial node (palm broker sign)

stage 4: aspergilloma occurs in devitalized lung

steroids improve s/sx but not affect long-term

granuloma is there to clear the antigen which is a good thing unless they go craze

Tx should not be based on ACE levels or other granulomatous markers, rather tx is based on s/sx