PMC5279080_01
(A) Chest X-ray showing a micronodular pattern. (B) HRCT scan showing diffuse small centrilobular nodules. (C) Presence of interbronchial lymph nodes. (D) Improvement of miliary pattern after steroid therapy.
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F1
C, respiratory rate was 24/minute, auscultation was normal and no extrathoracic signs were present. Chest X-ray showed diffuse micronodular opacities (Fig. 1A). High-resolution computed tomography (CT) demonstrated a profusion of well-delimited centrilobular micronodules, 2 mm in diameter, with subpleural sparing and a "bud in tree" pattern in some areas (Fig. 1B). Interbronchial lymph nodes were present (Fig. 1C). Improvement of dyspnea was observed after 1 month of treatment, and CT micronodules had dramatically decreased (Fig. 1D).
Histological examination of VATS lung biopsy. (A) Hematoxylin Phloxin Saffron staining (x2.5) proliferation of plump fibroblasts embedded in an edematous stroma forming intra luminal plugs in alveolar ducts and alveoli (arrows). Note the presence of a weak interstitial inflammatory infiltration at distance of fibrotic changes. No granuloma was observed in peribronchial areas or in interalveolar septa. (B) Orcein staining (x5). Buds of granulation tissue filling distal airspaces, extending from 1 alveolus to the next. Intraluminal fibrotic changes constitute the prominent lesion. No inflammation of vascular walls was observed.
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F2
Mild inflammatory infiltrates was seen around fibrotic areas but interstitial inflammation was not present at distance of fibrotic plugs (Fig. 2).