PMC9792951_01
Chest X-ray findings. (A) A huge mass shadow was observed in left upper lung field at the initial visit. (B) The tumor had regressed after second cycle of chemotherapy. (C) Bilateral GGOs, predominantly in left lower lung field, appeared after the third cycle of chemotherapy.
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Chest X-ray showed a huge mass shadow in his left upper lung field (Fig. 1A). The chemotherapy induced a partial response (Fig. 1B), but he developed respiratory failure after the third cycle of chemotherapy (Fig. 1C) and was admitted.
Chest computed tomography findings. The images before the administration of chemotherapy showed paraseptal emphysema but not GGOs or reticular shadows (A, B). After the third cycle of chemotherapy, subpleural and basal predominant reticular shadow, cystic structures, and peripheral traction bronchiectasis with volume loss were observed in the left lower lobe (C), and peribronchovascular consolidation with GGO was observed in the right lower lobe (D). The images at the onset of acute exacerbation showed additional bilateral GGO and consolidation with progressive traction bronchiectasis and volume loss of bilateral lower lobes (E, F). Methylprednisolone pulse followed by high-dose prednisolone and tacrolimus improved the GGO and consolidation (G, H).
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HRCT before the administration of chemotherapy showed slight cystic changes, we considered that these findings were mainly due to paraseptal emphysema (Fig. 2A and B). However, HRCT on the day of admission showed subpleural and basal predominant reticular shadow, cystic structures, and peripheral traction bronchiectasis with volume loss in his left lower lobe (Fig. 2C). In the right lower lobe, peribronchovascular consolidation with ground-glass opacity (GGO) was also observed. (Fig. 2D). HRCT showed additional bilateral GGO and consolidation with progressive traction bronchiectasis and volume loss of bilateral lower lobes (Fig. 2E and F). The treatments improved the GGO and consolidation and suppressed the progression of fibrosis (Fig. 2G and H).