PMC9877430_01
CT image showing (A, B) some nodules on the right upper lobe; (C, D) consolidation of the right upper lobe with an air bronchogram after antibiotic therapy administration in our hospital; (E, F) that the lesion was absorbed after treatment with dexamethasone; (G, H) more extensive lesions than previously observed after re-administering corticosteroids.
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F1
On chest CT, small nodules and small patchy consolidations were observed in the right lung, while patchy consolidations appeared in the left upper lung lobe and basement of the left lower lung (Figures 1A, B). CT was significantly larger than that before (Figures 1C, D). Consolidations and nodules in the right lung showed higher levels of 18F-fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography (PET) (Figure 2) with a maximum standardized uptake value (SUVmax) of 10.1. During dexamethasone treatment, the patient's body temperature was normal for several days, and the right lung consolidation appeared small (Figures 1E, F). However, the fever did not subside, and the consolidation on the CT image progressed (Figures 1G, H).
High levels of 18F-fluorodeoxyglucose uptake on the right lung observed on positron emission tomography.
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F2
CT was significantly larger than that before (Figures 1C, D). Consolidations and nodules in the right lung showed higher levels of 18F-fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography (PET) (Figure 2) with a maximum standardized uptake value (SUVmax) of 10.1.
(A) Histopathology of the lung showing multiple organizing "fibrin balls" (arrow) within alveolar spaces, and (B) histopathology of the bone marrow showing active hyperplasia.
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F3
Finally, after a percutaneous fine needle biopsy of the right lung mass confirmed AFOP, alveolar spaces were filled with abundant inflammatory fibrin exudate with an immature organization (Figure 3A). On execution of bone marrow biopsies, active bone marrow hyperplasia was observed, and the number of immature cells in the medullary cavity was significantly increased (Figure 3B).
The timeline of the case.
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F4
The progress and decision-making involved in this case are shown in the timeline (Figure 4).