PMC4682006_01
A: Chest X-ray in previous admission-showing Diffuse nodular shadows. B: CT-chest on previous admission - showing diffuse micronodules with prediliction for fissures and bronchovascular bundles.
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Chest X Ray (CXR) done at that time showed diffuse nodular shadows (Fig. 1A). CT chest demonstrated diffuse micronodules with prediliction for fissures and bronchovascular bundles and associated mediastinal lymphadenopathy (Fig. 1B).
A: Chest X-ray on presentation-Homogenous opacity of left lower zone with blunt costophrenic angle. B: CT-chest Mediastinal window - showing Pleural effusion with atelectasis on left side. C: CT-chest Lung window.
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His CXR and CT chest showed left sided massive pleural effusion (Fig. 2A-C).
A: Pleuroscopic view of Visceral pleura showing multiple nodular lesions. B: Pleuroscopic View of irregular and nodular diaphragmatic pleura.
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Pleuroscopy revealed multiple large nodules over parietal and visceral surfaces (Fig. 3A and B).
A: Bronchoscopic Picture showing irregular and edematous bronchial mucosa (B6). B: Endobronchial Biopsy showing noncaseating epitheloid cell granulomas. C: Transbronchial lung biopsy showing ill formed epithelioid granulomas.
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On fibreoptic bronchoscopy mucosa in left bronchial tree was grossly oedematous and irregular (Fig. 4A). Endobronchial biopsy showed noncaseating epitheloid cell granulomas with langhans cells (Fig. 4B). Transbronchial lung biopsy revealed nonspecific inflammation of interstitium with ill formed epithelioid granulomas (Fig. 4C).