PMC9619176_01
Frontal chest radiographs (CXR) on the date of admission (A) and 1 day after oesophagogastroduodenoscopy (EGD) (B) showing new development of multifocal patchy and nodular consolidations and ground-glass opacities in the left lung with a lower lung zone predominance. CXR obtained 1 week (C) after EGD showing interval progression of multifocal patchy and nodular consolidations and ground-glass opacities in both lungs. Follow-up CXR after treatment with dexamethasone for 1 week (D) showing interval resolution of multifocal consolidations and ground-glass opacities in both lungs.
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Chest radiography (CXR) demonstrated a new development of multifocal patchy and nodular consolidations, and ground-glass opacities in the left lung with a lower lung zone predominance (Fig. 1A-B). However, her symptoms rapidly deteriorated, and a progressive bilateral lung infiltration was demonstrated on CXR (Fig. 1C) after 1 week. Continuous improvement of the lesion was observed on the follow-up CXR (Fig. 1D).
Axial computed tomography (CT) of the chest in lung window (A-B) 1 week after oesophagogastroduodenoscopy showing multifocal peribronchovascular consolidations and patchy ground-glass opacities with superimposed interlobular septal thickening and intralobular lines (crazy-paving pattern). C. Histopathological findings (haematoxylin-eosin staining) from bronchoalveolar lavage fluid cell block showing clusters of neoplastic cells. These cells have large oval to irregular pleomorphic and hyperchromatic nuclei with vacuolated cytoplasm highly suggestive of adenocarcinoma. D. Histopathological findings (haematoxylin-eosin staining) from transbronchial lung biopsy showing interstitial inflammatory cells infiltration, fibroblasts proliferation, and pneumocyte type 2 hyperplasia with hyaline membranes compatible with organizing diffuse alveolar damage.
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C-reactive protein was 148.98 mg/L and that of procalcitonin was 0.17 ng/mL. Computed tomography (CT) of the chest showed multifocal peribronchovascular consolidations and patchy ground-glass opacities with superimposed interlobular septal thickening and intralobular lines (Fig. 2A and B). The BALF cytology and cell block were positive for malignant cells, consistent with metastatic adenocarcinoma and did not demonstrate bilirubin crystallisation (Fig. 2C). Histopathological examination of a transbronchial biopsy demonstrated organizing diffuse alveolar damage (DAD) (Fig. 2D) with no evidence of food particles or bile pigment.