PMC8517250_01
Clinical course of the patient. (A) Stage 1: from pathogeny to intubation. (B) Stage 2: ECMO stage. (C) Stage 3: transplant and post-transplant stages.
fmed-08-742823-g0001.jpg
PMC8517250_01_fmed-08-742823-g0001.jpg
F1
The patient's clinical course is shown in Figure 1.
Computed tomography (CT) image of the chest. (A) CT of the chest shows bilateral ground glass opacities 9 days before intubation. (B) CT of the chest shows bilateral pulmonary patchy infiltrates, which was considered as interstitial pneumonia 3 days before intubation (arrowheads). (C) CT of the chest shows bilateral pulmonary extensive infiltrates and lobular interstitium thickness, which was considered as pulmonary fibrosis 23 days after ECMO (arrowheads). (D) CT of the chest showed bilateral pulmonary scattered infiltration 3 days after lung transplantation.
fmed-08-742823-g0002.jpg
PMC8517250_01_fmed-08-742823-g0002.jpg
F2
Computed tomography (CT) of the chest showed bilateral ground glass opacities (Figure 2A). CT of the chest showed bilateral pulmonary patchy infiltrates, and interstitial pneumonia was considered (Figure 2B). China, the patient received a nucleic acid test for COVID-19, but the result was negative. CT of the chest showed bilateral pulmonary extensive infiltrates and lobular interstitium thickness, and pulmonary fibrosis was considered (Figure 2C). CT of the head was normal (Figure 3A), and the patient was conscious after withdrawal of the sedative. The patient's respiratory status gradually improved, and CT of the chest showed bilateral pulmonary scattered infiltration (Figure 2D), which was improved compared with previous imageological diagnosis.
Computed tomography (CT) image of the head. (A) CT of the head is normal at the ECMO stage. (B) CT of the head shows bilateral parieto-occipital low-density lesions at day 3 after transplantation (arrowheads).
fmed-08-742823-g0003.jpg
PMC8517250_01_fmed-08-742823-g0003.jpg
F3
China, the patient received a nucleic acid test for COVID-19, but the result was negative. CT of the chest showed bilateral pulmonary extensive infiltrates and lobular interstitium thickness, and pulmonary fibrosis was considered (Figure 2C). CT of the head was normal (Figure 3A), and the patient was conscious after withdrawal of the sedative. Head CT showed bilateral parieto-occipital low-density lesions, which were considered to be due to PRES (Figure 3B).
Microscopic examination of the explanted lung (hematoxylin-eosin stain, x50) shows extensive consolidation of lung tissue and pulmonary interstitial fibrosis (arrowheads). Ring fibrosis connecting alveolar orifice rings and inflammatory cell infiltration into the alveolar walls with pneumocyte hyperplasia and squamous metaplasia.
fmed-08-742823-g0004.jpg
PMC8517250_01_fmed-08-742823-g0004.jpg
F4
Her explant pathology showed extensive consolidation of lung tissue and pulmonary interstitial fibrosis (Figure 4).