PMC4821337_01
On initial evaluation, high resolution computed tomography of the chest shows bilateral interstitial reticular pattern on the lower lobes with mild honey combing.
gr1.jpg
PMC4821337_01_gr1.jpg
fig1
A high-resolution computed tomography (CT) of the chest revealed a bilateral prominent interstitial reticular pattern predominantly in the lower lobes and subpleural regions with mild honeycombing (Fig. 1), consistent with IPF.
Video assisted thoracoscopic lung biopsy showed chronic active interstitial pneumonitis and fibrosis representing usual interstitial pneumonia pattern.
gr2.jpg
PMC4821337_01_gr2.jpg
fig2
Histopathology demonstrated a usual interstitial pneumonia (UIP) pattern, corresponding to the clinical diagnosis of IPF (Fig. 2).
Repeat high resolution computed tomography of the chest done for worsening symptoms reveals increasing fibrosis and traction bronchiectasis.
gr3.jpg
PMC4821337_01_gr3.jpg
fig3
A repeat CT of the chest demonstrated bilaterally increasing interstitial fibrosis and traction bronchiectasis (Fig. 3).
Double contrast barium swallow done 3 months following laparoscopic Heller's myotomy with fundoplication shows persistent dilatation at the region of fundoplication.
gr4.jpg
PMC4821337_01_gr4.jpg
fig4
A double contrast barium swallow revealed no evidence of a leak and persistent dilatation at the region of fundoplication (Fig. 4).
Computed tomography of the chest done 3 months after the surgery reveals extensive honey combing and ground glassing indicating superimposed pneumonitis.
gr5.jpg
PMC4821337_01_gr5.jpg
fig5
Repeat imaging revealed severe extensive honey combing and air trapping with superimposed ground glassing (Fig. 5).