PMC9872202_01
Chest CT of tracheal carina level in the lung and mediastinum windows. dynamic changes of the space-occupying lesions. (A)/(F) A space-occupying lesion (2.9 x 2.6 cm) in the upper lobe of the right lung. (B)/(G) The primary foci shrank significantly and was surrounded by GGOs and consolidation shadow. (C)/(H) Multiple GGOs, reticulation, grid lesions, and traction bronchiectasis in the dominant lobe around the primary foci with patchy lesions in the opposite lobe. (D)/(I) A recurred lobulated mass (5.0x2.6 cm) in the upper lobe of the right lung. (E)/(J) Mildly reduced lesion (4.2x4.3 cm).
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During a routine examination in December 2020, a space-occupying lesion (2.9 cm x 2.6 cm) near the lung hilum (Figures 1A, F) and mild fibrotic changes of unclear origin were detected (Figures 2A, F). Images showed that the primary cancer foci shrank significantly and were surrounded by patchy ground-glass opacities (GGOs) and consolidation shadows (Figures 1B, G). On 2 April 2021, the patient's ECOG score was rated 4 before discharge; lung CT reexamination showed no new space-occupying lesions, and the original occupation was significantly smaller than the previous one in December 2020 (Figures 1C, H). Multiple GGOs, reticulation, grid lesions, and traction bronchiectasis in a cryptogenic organizing pneumonia (OP) pattern were found in the dominant lobe around the primary tumor site, with patchy lesions in the opposite lobe (Figures 1C, H). The CT scan showed a lobulated mass with a size of 5.0 cm x 2.6 cm in the upper lobe of the right lung, surrounded by fine burrs and thick-walled cavities (Figures 1D, I). Lung CT examination showed that the former shadow was 4.2 cm x 4.3 cm in size (Figures 1E, J) and stable mild interstitial changes (Figures 2E, J).
Chest CT of inferior lungs in the lung and mediastinum windows. Dynamic changes in the interstitial lesions in the bilateral inferior lobes of the lung. (A)/(F) Mild basic interstitial changes. (B)/(G) Significant peribronchovascular and subpleural GGOs, reticulation, and consolidation. (C)/(H) Significant fibrotic with GGOs, reticulation, consolidation, honeycomb shadows, and thickened interlobular septa. (D)/(I) Significantly improved interstitial changes and better transparency. (E)/(J) Stable mild interstitial changes.
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During a routine examination in December 2020, a space-occupying lesion (2.9 cm x 2.6 cm) near the lung hilum (Figures 1A, F) and mild fibrotic changes of unclear origin were detected (Figures 2A, F). Bilateral peribronchovascular and subpleural GGOs, reticulation, and consolidation were predominant in the middle to lower lungs (Figures 2B, G). The bilateral lower lungs were predominantly fibrotic with GGOs, reticulation, consolidation, honeycomb shadows, and thickened interlobular septa (Figures 2C, H). The interstitial changes in the bilateral lower lobes were significantly improved compared to the previous films (Figures 2D, I). Lung CT examination showed that the former shadow was 4.2 cm x 4.3 cm in size (Figures 1E, J) and stable mild interstitial changes (Figures 2E, J).
Dynamic changes in laboratory examination: inflammatory reaction, hypoxia with hypercoagulable state (A-D).
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Laboratory examination revealed an inflammatory blood reaction (Figures 3A, B), decreased oxygen partial pressure (Figure 3C), decreased oxygen saturation (85% SaO2), and increased D-dimer levels (>=20 mug/ml) (Figure 3D). Two days after immunomodulatory treatment, the inflammation indicators increased again (Figures 3A, B), and plenty of sticky sputum was collected from the patient. After 3 days, the temperature and laboratory indicators improved (Figure 3).
Bedside chest radiograph: both lung translucency and consolidation shadow decreased after treatment (A, B).
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Bedside chest radiography revealed poor lung transparency (Figure 4A). Bedside chest radiography showed improved bilateral lung transmittance (Figure 4B).
The management axis of acute severe steroid-refractory CIP.
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 Figure 5 shows the management axis of CIP G4 and the critical complications in this patient.
The time axis of anti-tumor therapy.
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The process of antitumor therapy for the patient is shown in Figure 6.