PMC10212751_01
Computed tomography image showing ground-glass opacity, traction bronchiectasis, interlobular wall thickening, and bilateral and diffuse reticular shadows compatible with fibrotic HP.
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Chest computed tomography (CT) revealed ground-glass opacity (GGO), traction bronchiectasis, interlobular wall thickening, and bilaterally diffused reticular shadows predominantly in the lower lobes, without centrilobular nodules (Fig. 1).
Hematoxylin and eosin stain of TBLB showing lymphocytic infiltration, mild thickening due to fibrosis and hyperplasia of type II pneumocytes in the alveolar wall.
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TBLB revealed lymphocytic infiltration, mild thickening due to fibrosis, and hyperplasia of type II pneumocytes in the alveolar wall (Fig. 2).
Computed tomography showing ground-glass opacity spreading throughout the lung field, with marked thickening of the interlobular septum, resulting in a so-called crazy-paving appearance.
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Three months later, dyspnea on exertion worsened, the chest CT showed GGO spreading throughout the lung field with marked thickening of the interlobular septum, resulting in a so-called crazy-paving appearance (Fig. 3), and the KL-6 level increased to 26,974 U/mL (Fig. 4).
Hematoxylin and eosin stain of TBLB showing the alveolar space filled with acidophilic, unstructured material (A). Periodic acid-Schiff staining (B) and surfactant apoprotein A staining (C) also gave positive results.
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TBLB showed an alveolar space was filled with acidophilic, unstructured material on hematoxylin and eosin staining (Fig. 5A), which tested positive for granules on Periodic acid-Schiff stain (Fig. 5B) and also on Surfactant apoprotein A staining (Fig. 5C).