PMC4356029_01
HRCT images (a-b, before surgical biopsy: f, 4 months after the cessation of smoking) and pathological findings (c-e). (a) the upper zones of the lungs showing paraseptal and centrilobular emphysema. (b) the lower zones of the lungs showing ground-glass opacity and reticular patterns. (c) irregular interstitial fibrosis with mild chronic inflammation. (d) emphysema in the non-fibrotic lesion. (e) intraluminal accumulation of macrophages. (f) marked improvements in ground-glass opacity and reticular patterns.
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HRCT demonstrated mild emphysema in the upper lung fields (Fig. 1a). HRCT also revealed ground-glass opacity and reticular patterns without honeycombing in the lower lung fields, which were consistent with an NSIP pattern. A crazy-paving pattern, which was previously reported to be frequent in non-smokers with NSIP, was not observed (Fig. 1b). The main finding of the surgical biopsy specimen (rS9) was irregular interstitial fibrosis with mild chronic inflammation, which ranged from the peripheral to the central part of lobule (Fig. 1c). These pathological findings were consisted with that of fibrotic NSIP, and centrilobular emphysema in the non-fibrotic lesion and focal intraluminal accumulation of macrophages suggested superimposed smoking effects (Fig. 1d,e). Moreover, ground-glass opacity and reticular patterns on HRCT were found to have gradually improved without medication during the next 4 months (Fig. 1f) and KL-6 was reduced to 392 U/ml.