PMC6122309_01
Imaging findings at the initial examination. Chest radiography showed hyperlucency in both lungs and bilateral coarse reticular shadows in the lower lung field. On high-resolution CT, both centrilobular and paraseptal emphysema were seen in the upper lung zones on both sides and bilateral subpleural reticular and ground-glass opacities surrounding the emphysematous cysts were found in the lower lobes.
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Chest radiography showed hyperlucency in both lungs and bilateral coarse reticular shadows in the lower lung field. (Fig. 1). On high-resolution CT, both centrilobular and paraseptal emphysema were seen in the upper lung zones on both sides, and bilateral subpleural reticular and ground-glass opacities surrounding the emphysematous cysts were found in the lower lobes. (Fig. 1).
VATS lung biopsy showed emphysema and inflammatory cell infiltration with airway-centered respiratory bronchitis on segment 2, and some part of segment 8 showed nonspecific interstitial pneumonia (NSIP)-like diffuse fibrotic changes, while others showed unusual interstitial pneumonia (UIP)-like peripheral chronic fibrosis adjacent with a normal lung, a few fibroblastic foci, and microscopic honeycombing. There were no signs of vasculitis, granuloma, and other causes of ILD.
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Some part of segment 8 showed a nonspecific interstitial pneumonia (NSIP) pattern, while others showed a usual interstitial pneumonia (UIP) pattern, such as few fibroblast foci with chronic fibrosis and abrupt changes in normal lesions with microscopic honeycombing (Fig. 2).
No obvious change in chest CT after the 1- and 2-year follow-up examinations.
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