PMC4356049_01
Chest X-ray, (during first hospitalization) shows extensive basilar-predominant fibrosis, pleural thickening and possible pneumonic infiltrates in bilateral lower lobes of the lungs. No previous CXR was available for comparison.
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CXR showed extensive basilar fibrosis, pleural thickening and possible basilar infiltrates (Fig. 1).
CT scan of the chest (during first hospitalization) shows pleural thickening and severe fibrotic changes with honeycombing in both lungs.
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Chest computed tomography (CT) scan with intravenous contrast showed severe fibrotic changes in both lungs, with honeycombing especially at the lung bases and diffuse pleural wall thickening (Fig. 2).
Histology from VATS lung biopsy reveals A) marked fibrosis and chronic inflammation with B) giant cell reactions (hematoxylin-eosin, A.25x B.100x). An arrow shows a multi-nucleated giant cell.
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A biopsy specimen from left lower lung demonstrated marked interstitial chronic inflammation, subpleural interstitial fibrosis and numerous prominent multi-nucleated giant cells, consistent with Giant Cell Interstitial Pneumonia (Fig. 3A and B).
Chest X-ray, (4 months after initial hospitalization) shows minimal left sided pleural effusion and a significant decrease in the pulmonary infiltrates and pleural thickening.
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CXR at that time showed a significant decrease in the pulmonary infiltrates and pleural thickening (Fig. 4).
Chest X-ray (during second hospitalization) shows a dramatic increase in bilateral opacities compared with previous CXR.
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CXR performed that day showed extensive bilateral interstitial infiltrates and opacities (Fig. 5).
A: PFT performed approximately 2 months after the initial hospitalization shows a severe obstructive and a moderate restrictive ventilation defect and moderately decreased DLCO. B: PFT performed approximately 4 months later shows a significant improvement with a mild restrictive ventilatory defect, resolution of the obstructive ventilatory defect and only a mildly reduced DLCO.
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Pulmonary Function Testing (PFT) performed soon after hospital discharge showed a severe obstructive and moderate restrictive ventilatory defect which improved significantly on follow-up PFT performed five months later (Fig. 6A and B).