PMC4681975_01
AP and lateral chest radiographs. Non-specific perihilar interstitial thickening and pulmonary hyperaeration suggestive of infectious or reactive small airways disease. Incidental finding of pectus excavatum.
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Chest radiograph done at the initial pulmonology clinic visit showed hyper-inflated lungs with diffuse interstitial thickening initially attributed to small airways disease, possibly secondary to viral bronchiolitis or asthma (Fig. 1).
High-resolution chest CT. A. Axial image shows patchy ground glass opacification involving the right middle lobe (long black arrow) and lingula (short black arrow). B. Ground glass opacities are likewise predominantly central in location (arrows). C. Coronal image shows areas of air-trapping (white arrows).
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The chest CT showed scattered areas of ground glass opacification and mosaic attenuation likely from air trapping (Fig. 2).
The wedge biopsy of right middle lobe of lung shows generally normal alveolar architecture and bronchioles (A) with reactive lymphoid hyperplasia (C). The immunohistochemistry for synaptophysin highlights multiple small clusters of neuroepithelial cells within both normal bronchioles and bronchioles with reactive lymphoid hyperplasia (B and D).
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The clusters of NECs and occasional large neuroendocrine bodies are noted in both normal bronchioles and bronchioles with reactive lymphoid hyperplasia (Fig. 3).