PMC3117630_01
CT chest after 10 months of treatment with gemcitabine with findings significant for 1.7 cm x 1.3 cm left lower lobe lesion (not pictured in this cut) and loculated left pleural effusion.
cmo-1-2011-171f1.jpg
PMC3117630_01_cmo-1-2011-171f1.jpg
f1-cmo-1-2011-171
She was known to have metastatic disease to the lung with a known 1.7 cm x 1.3 cm left lower lobe lesion and a small loculated left pleural effusion at the time of symptom onset, which had been stable for a two year period (Fig. 1).
CT chest after 12 months of treatment with gemcitabine revealing ground glass opacities, right pleural effusion, and septal wall thickening.
cmo-1-2011-171f2.jpg
PMC3117630_01_cmo-1-2011-171f2.jpg
f2-cmo-1-2011-171
CXR was negative for infiltrates. CT of the thorax was negative for pulmonary embolism but did reveal ground glass opacities bilaterally with a new right effusion as well as septal wall thickening suspicious for edema (Fig. 2).
Pathology revealing a chronic bronchiolitis with a mononuclear alveolar septal infiltrate associated with poorly formed granulomas at the upper left (H&E, x200).
cmo-1-2011-171f4.jpg
PMC3117630_01_cmo-1-2011-171f4.jpg
f4-cmo-1-2011-171
However, also present were background features of a patchy mononuclear infiltrate associated with poorly formed granulomas and focally associated pulmonary parenchymal scarring consistent with hypersensitivity pneumonitis (Fig. 4).