PMC5315435_01
HRCT scans of the chest. (A, B) At initial presentation: Emphysema and mild GGO in the upper lobes, and uniform GGO with lower zone predominance. (C, D) After smoking cessation: Little change is evident in the upper lobes, while bilateral shadows in the lower lobes show mild improvement.
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High-resolution CT (HRCT) showed emphysematous change and mild GGO in the upper lobes (Fig. 1A), and uniform GGO in the lower lobes (Fig. 1B).
Pathological findings from VATS lung biopsy. (A) Right. S2: Panoramic view showing bronchiolocentric accentuation of macrophage accumulation and peribronchiolar fibrosis. (hematoxylin-eosin, x 1), (B) Right. S2: Large macrophages admixed with eosinophils in the alveolar lumina and infiltration of plasma cells in the alveolar walls. (hematoxylin-eosin, x20), (C) Right. S8: Fibrotic NSIP with mild accumulation of macrophages in the alveolar lumina and lymphoid follicles. (hematoxylin-eosin, x3).
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Histopathological findings of biopsy specimens showed bronchiolocentric-accentuated accumulation of macrophages, and peribronchiolar fibrosis in a right S2 lesion (Fig. 2A and B). Another specimen from right S8 showed fibrotic nonspecific interstitial pneumonia (f-NSIP) with mild accumulation of macrophages in the alveolar lumina and lymphoid follicles (Fig. 2C).
Elemental analysis. (A) Quantitative elemental analysis of the right S2 lesion shows characteristic X-ray features on the horizontal axis and intensity on the vertical axis. This indicates high levels of aluminum deposition. (B-E) Elemental analysis showing nitrogen (green) and other particles (orange). S2 lesions with deposition of aluminum (B) and iron (C). Right S9 lesion shows no deposition of aluminum (D), but there is deposition of iron (E).
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High amounts of aluminum were detected in S2 and high levels of iron in S2 and S9 (Fig. 3A-E).