PMC4380606_01
HRCT scans at the initial presentation of the disease.
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High-resolution computed tomography (HRCT) scans showed interstitial shadowing and diffuse small nodules, a subpleural reticular pattern and mediastinal lymphadenopathy in all areas (subcarinal lymph nodes 29 x 20 mm) (Fig. 1).
Transbronchial lung biopsy.. The picture clearly shows a silicotic nodule (asterisk) and lung tissue with
thickened alveolar septa infiltrated with lymphocytes and histiocytes. In the alveoli,
PAS-positive protein material is present, corresponding to surfactant in alveolar
lipoproteinosis (upper arrow). In some alveoli, there are optically empty spaces
previously occupied by cholesterol crystals (lower arrow). PAS staining, 100x
magnification.
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Diffuse fibrosis of the alveolar septa had not yet developed (Fig. 2).
VATS biopsy.. Approximately 6 months after transbronchial biopsy. The subpleural lung regions
contain compact fibrotic lesions (asterisk) with numerous cholesterol crystals
(arrows). HE staining, 200x magnification.
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In the subpleural region, compact fibrosis with numerous cholesterol crystals had developed (Fig. 3).
HRCT scans after 2 years of disease progression.
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After 2 yr, significant signs of disease progression were revealed by chest X-ray and HRCT scans, with more pronounced mediastinal lymph node enlargement, diffuse ground-glass opacities, foci of consolidation, reticular pattern, nodules and pleural thickening (Fig. 4).