PMC5846918_01
Image of the patient showed right side pneumothorax in a supine chest X-ray (a). Computed tomography of the chest (b) and (c) showed consolidations (red arrow) and reticular opacities (green arrow) involving bilateral pleural and subpleural regions indicating fibrosis at upper and middle lung zones, in addition to the right pneumothorax (yellow star).
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Chest radiograph showed a small amount of right side pneumothorax (Figure 1(a)). In addition, consolidations and reticular opacities involving the pleural and subpleural regions indicating fibrosis at bilateral upper and middle lung zones were noted (Figure 1(b) and (c)).
Microscopic examination of H&E stains of the patient's right upper lobe (a), right middle lobe (b) and right lower lobe (c) all showed thickening of the visceral pleura and subpleural parenchymal fibrosis, with abrupt transition to normal parenchyma distant from pleura. A small amount of lymphoplasmacytic infiltration was present. EVG stain (d) showed heavy deposition of elastin fibers, some showing preserved alveolar septal pattern. All photos taken at 40x magnification. Scale bar: 1 mm.
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Fibrosis of the visceral pleura was noted in the specimens from all three lobes, more significant in the upper lobe (Figure 2(a) -(c)). Elastic Van Gieson (EVG) stain was performed and showed a pattern of alveolar septal elastosis with intra-alveolar fibrosis (Figure 2(d)).