PMC4501504_01
CT chest with contrast showing small filling defects at sub segmental left lower lobe and right lower lobe.
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A CT scan of the chest with contrast revealed small filling defects at the sub segmental level in both lower lobes (Fig. 1) diagnostic of pulmonary embolism.
1 and 2. CXR before and after treatment.
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Multiple alveolar opacities were noted in both lungs on chest radiography (Fig. 2.1). There was dramatic and rapid improvement with reduction in oxygen requirements and significant radiographic clearing (Fig. 2.2) over the next 4 days.
Heterogeneous opacification of the lungs centrally with sparing the lung periphery diagnostic of the lung hemorrhage, with small sub pleural nodular opacities in the upper lobes diagnostic of silicosis.
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There were numerous small sub pleural nodules as well as mediastinal and hilar adenopathy, consistent with a diagnosis of silicosis (Fig. 3).
Small bilateral pleural effusion and mild to moderate pericardial effusion with enhancement of the pericardium.
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Light microscopy showing glomeruli with cellular crescents and fibrin deposits. H&E staining, 20x.
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A renal biopsy revealed changes compatible with active pauci-immue glomerulonephritis with focal and segmental fibrinoid necrosis associated with small cellular crescents (Fig. 5).