PMC5608601_01
CT images at admission. At admission, CT scan showed demonstrated extensive shadows of high density in left lung, inburst into mediastinum, with bronchial ventilation sign, pleural thickening, and enlargement of lymph nodes in hilum and mediastinum. There was no obvious abnormal enhancement.
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No abnormal enhancement was showed (Fig. 1).
Bronchofibroscope images. Bronchofibroscope was performed after CT scan. Bronchofibroscope images showed mucosa thickening and tracheobronchial stenosis in left lung. No neoplasm and caseous necrosis were found in the lumen.
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Bronchofibroscope showed mucosa thickening and tracheobronchial stenosis in left lung (Fig. 2).
Pathological images (A) Pathological images of biopsy by Bronchofibroscope, indicated interstitial fibrous tissue hyperplasia and a large number of chronic inflammatory cell infiltration. (B) Pathological images of biopsy by percutaneous lung puncture from the left lower lobe, also indicated interstitial fibrous tissue and many chronic inflammatory cells without specificity.
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Transbronchial biopsy indicated interstitial fibrous tissue hyperplasia and chronic inflammatory cell infiltration (Fig. 3A). Percutaneous biopsy from the left lower lobe also indicated interstitial fibrous tissue and chronic inflammatory cells without specificity (Fig. 3B).
PET-CT images after one month. After 10 days antibiotic therapy with amoxicillin/clavulanic acid and roxithromycin, the symptom improved, medication discontinued. PET-CT scan was arranged one month after admission. PET-CT showed high density shadow in left lung with increased metabolism, without obvious change than before.
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The results showed high density shadow in left lung with increased metabolism, without obvious change in the range than before (Fig. 4).
CT images after corticosteroid treatment. After one month oral corticosteroid therapy, the shadow of left lung had dramatically decreased than before. New small shadow appeared in right lung (red arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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Steroids were tapered over 6 months and lung CT scans significantly improved (Fig. 5). But new small shadow appeared, as the sign of recurrence (Fig. 5).
Pathological images. Biopsy by percutaneous lung puncture from the right upper lobe (the new lesion appeared in Fig. 5), interstitial fibrous tissue and many chronic inflammatory cells, granulation tissue plugs in the lumen of alveoli.
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The patient underwent percutaneous biopsy again, and finally, the pathological manifestation indicated OP by finding granulation tissue plugs in the lumen of alveoli (Fig. 6).