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Objectives IgG4 related disease is an autoimmune condition that often leads to diagnostic challenges which can often delay timely treatment. It rarely presents with pulmonary findings which can radiologically mimic cancer. We describe a unique case of an incidentally diagnosed IgG4- related lung disease (IgG4-RLD). Case description A 32-year-old healthy female suffered a car accident and had a CT Trauma. This revealed an indeterminate soft tissue lesion in the middle lobe of the right lung with an endobronchial component of uncertain histology which had central extension into the right inferior hilum. She had a bronchoscopic biopsy revealing that the mass was an Inflammatory Myofibroblastic Tumour (IMT). Due to the close relationship of this tumour with the root of her right lung, she was planned for a right pneumonectomy. However, it was agreed for that she underwent another bronchoscopy with biopsy to obtain more histology before proceeding with a pneumonectomy for the uncertainty about the diagnosis of an IMT and due to the absence of distinct clinical features from this mass. This revealed that the mass was highly suggestive of IgG4-RLD. Her blood tests revealed high serum IgG4 levels which confirmed the diagnosis of IgG4-RLD. Conclusion IgG4-RLD is a rare condition which can seldom be diagnosed incidentally. Patients with biopsies suggestive of IMT should undergo a repeat biopsy before proceeding to surgical resection of the tumour. Alternatively, a serum IgG4 level can also be deemed a useful tool for screening such patients.

EP.TU.182Surgical Serendipity: The Accident that Exposed an Autoimmune disease