PMC6038654_01
CT-high resolution chest without contrast. Taken 15 months before acute exacerbation. Ground glass opacities with thickening of the interlobular septa, predominantly in the lung bases.
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Our patient is a 58-year-old Caucasian male referred initially to the pulmonary clinic for an abnormal high resolution computed tomography (HRCT) of the chest (Figure 1) showing ground glass opacities (GGOs), thickening of the interlobular septa primarily in the bases with minimal honeycombing, mediastinal adenopathies, and small bilateral pleural effusions.
Low power overview showing DIP and RB-ILD with adjacent normal but slightly inflamed lung.
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Right lower and right upper lobe wedge excisions revealed classic desquamative interstitial pneumonia, along with foci of respiratory bronchiolitis interstitial pneumonia, mild interstitial fibrosis, and emphysematous changes (Figures 2 and 3).
10x lung view showing dense accumulation of intra-alveolar macrophages. Classic histological DIP findings.
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Right lower and right upper lobe wedge excisions revealed classic desquamative interstitial pneumonia, along with foci of respiratory bronchiolitis interstitial pneumonia, mild interstitial fibrosis, and emphysematous changes (Figures 2 and 3).
Anteroposterior chest X-ray taken at the hospital admission during acute exacerbation of DIP. Right pleural effusion and bilateral lung interstitial opacities.
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A chest X-ray (Figure 4) and a chest CT angiogram (Figure 5) were ordered.
Chest CT angiogram taken during the acute exacerbation. Right pleural fluid filling 1/4 of chest, bilateral interstitial, and airspace disease. Ground glass opacities, pathological adenopathies in the mediastinum, cardiomegaly, and no pulmonary embolus.
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A chest X-ray (Figure 4) and a chest CT angiogram (Figure 5) were ordered.
Anteroposterior chest X-ray 10 days after acute exacerbation and treatment with glucocorticoids. Right pleural effusion resolved with improvement in interstitial opacities.
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Ten days after discharge, an office-visit chest X-ray (Figure 6) showed complete resolution of the pleural effusion and bilateral interstitial and airspace diseases markedly improved.