PMC5757588_01
(A) Radiography at admission revealed extensive ground-glass opacity (GGO) in the bilateral upper lung fields, and GGO predominantly on the lateral segments of the lungs. (B) Computed tomography at the time of examination. Extensive GGO is seen in the upper lobes, accompanied with traction bronchiectasis. Non-segmental GGO is seen in the lateral segments of lungs bilaterally, and a curvilinear shadow can be seen. (C) Chest radiography taken after 4 weeks of treatment. The opacity has almost disappeared.
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Chest radiography revealed opacities in the bilateral upper lung fields with extensive bilateral ground-glass opacity (GGO) predominantly around the lateral segments of the lungs (Fig. 1A). Chest computed tomography (CT) revealed GGO and traction bronchiectasis throughout the entire bilateral upper lobes; non-segmental GGO with curvilinear shadow was also observed in the middle lobe, lingula, and bilateral lower lobes (Fig. 1B). After 2 weeks of treatment, chest radiography showed that the extensive GGO had markedly ameliorated (Fig. 1C).
(A) Neutral lipid-laden macrophages in bronchoalveolar lavage fluid. (B) Intra-alveolar organization and multinucleated giant cells. With eosinophilic exudate, cuboid type II epithelial growth can be seen. (C) Multinucleated giant cells can be seen in the alveolar ducts (arrow). (D) Macrophages containing blackish-brown particles with eosinophilic and neutrophilic exudate can be seen in the alveolar space.
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Abundant lipid-laden macrophages were observed upon Oil Red O staining of BAL fluid (Fig. 2A). Lung histological examination revealed lesions with acute changes, alveolar septum swelling, and eosinophil and neutrophil invasion, with intra-alveolar invasion of eosinophils and neutrophils; in addition, abundant macrophages containing blackish-brown pigment and multinucleated foreign-body giant cells and intra-alveolar organization (Fig. 2B-D).