PMC9257402_01
A-C. A. Initial chest radiograph showing extensive multifocal airspace consolidation in both lower lobes.. B. Axial chest CT scan with lung-window setting showing diffuse widespread peribronchovascular ground-glass opacities and dense consolidation more in both lower lobes.. C. The follow-up chest radiography obtained after receiving pulsed corticosteroids, cyclophosphamide, and completed six sessions of plasmapheresis showing a marked decrease in the size of alveolar opacity at the bilateral lower lobes.
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Initial chest radiography (Fig. 1A) showed new extensive bilateral coalescent alveolar opacities with lower lungs predominance. Computed tomography (CT) scan of the chest (Fig. 1B) demonstrated diffuse bilateral widespread peribronchovascular ground-glass opacities and dense consolidation more in both lower lobes. Following the intensive immunosuppressive therapy, the patient showed clinical improvement evidenced by a decrease in the need for oxygen and ventilatory support along with gradually improved radiological findings allowing her to be extubated and discharged on the eighth and twentieth hospital days respectively (Fig. 1C).
A-B. A. Sequential bronchoalveolar lavage (BAL) starting left to right showing progressively more bloody effluent in the serial samples that suggestive of alveolar hemorrhage.. B. Histopathologic sections of the right lower lobe biopsies reveal organizing diffuse alveolar hemorrhage, no evidence of vasculitis or granuloma, or malignancy (H&E stain, 400x).
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Sequential bronchoalveolar lavage (BAL) was performed and showed progressively more bloody effluent in the serial samples that was highly suggestive of alveolar hemorrhage (Fig. 2A). Histopathologic sections of transbronchial biopsies revealed organizing diffuse alveolar damage (Fig. 2B).