PMC10131122_01
Chest CT (A) Images at diagnosis Chest CT showing bilateral multiple nodular lesions surrounded by ground-glass opacities and fibrotic changes are evident. (B) Images 7 years after the diagnosis The nodules decreased slightly and calcification appeared compared to the diagnostic images. The fibrotic changes have progressed, suggesting chronic inflammation. (C) Images 18 years after the diagnosis. The emphysematous changes progressed.
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A chest X-ray revealed pulmonary nodules and diffuse interstitial shadows, and a computed tomography (CT) scan of his lungs indicated multiple nodular lesions surrounded by ground-glass opacities (Fig. 1A). A CT scan revealed extensive ground-glass opacities (Fig. 1B). The chest imaging findings at this time were more aggravated than before (Fig. 1, Fig. 3B).
Pathological features of the lung tissue obtained from the patient. (A) Periodic acid-Schiff staining: Hyalinized lamellar collagen bundles were found centrally, surrounded by lymphocytic and plasma cell infiltrates in a perivascular distribution (left panel x 10; scale bar, 200 mum), Images of organizing granulomatous nodules of the lung with a high degree of chronic inflammation, and a mixture of lymphocytes and plasma cells at the margins (middle panel x 20; scale bar, 100 mum, right panel x 40; scale bar, 50 mum). (B) Masson's trichrome staining: Inflammatory cells, including lymphocytes and occasional plasma cells and macrophages were seen between the collagen bundles ( x 10; scale bar, 200 mum). (C) Immunohistochemical staining for CD68 revealed macrophages ( x 10; scale bar, 200 mum).
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Thoracoscopic lung biopsy led to a pathological diagnosis of PHG (Fig. 2).
Chest X-ray (A) Image 7 years after the diagnosis Chest X-ray shows pulmonary nodules, diffuse ground-glass opacities, and reticular shadows. (B) Image 18 years after the diagnosis. The diffuse ground-glass opacities and reticular shadows progressed.
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He developed dyspnea during physical activity 7 years after the diagnosis, with X-rays showing exacerbation of the pulmonary nodules, diffuse ground-glass opacities, and reticular shadows (Fig. 3A).