PMC7157807_01
Chest X-ray showing extensive patchy bilateral consolidation.
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Chest X-ray noted diffuse, bilateral pulmonary consolidation sparing the apices, and bases with bronchopulmonary cuffing (Figure 1).
CT of the thorax showing extensive bilateral infiltrates and ground glass type densities (black arrow) sparing the periphery.
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Computed tomography (CT) imaging showed extensive bilateral airspace disease with increased reticulation, traction bronchiectasis, and ground glass opacities but noted sparing of apical spaces bilaterally (Figure 2).
Lung biopsy showing organizing pneumonia and foamy macrophages (black arrow). (Hematoxylin-eosin, original magnification x400).
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Bronchoscopy with transbronchial biopsies were performed and a sample from the right lower lobe was significant for intra-alveolar inflammation including foamy macrophages and activated type II pneumocytes (Figure 3).
Bronchoalveolar lavage fluid stained with Oil red O highlights numerous macrophages containing lipid deposits, marked with black arrows (lipid-laden macrophages).
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A histopathology examination on bronchoalveolar lavage (BAL) sample stained with Oil red O showed numerous lipid-laden macrophages and intra-alveolar macrophages containing blackish-brown pigment (Figure 4).