PMC4532041_01
The initial chest radiolograph shows multiple air space consolidations bilaterally.
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The electocardiogram showed normal sinus rhythm with complete right bundle branch block pattern. The chest P-A showed confluent increased density in right upper lobe, right middle lobe and both lower lobes with blunting of left costophrenic angle, and also Derlie's B line in both lower lung fields (Fig. 1).
The chest roentgenogram on the 5th hospital day shows aggravated airspace consolidation in both lung fields.
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The follow-up chest X-ray, five days after antibiotics, revealed aggravated and migrating confluent alveolar consolidations (Fig. 2).
The High-resolution CT of the lung shows ground-grass opacities, airspace consolidation and interlobular septal thickening bilaterally.
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The high resolution computed tomography revealed patchy or lobar distributed increased opacities with air-bronchograms on both upper lobes, right middle lobe and both lower lobes, thickening of interlobular septums and also noted bilateral minimal pleral effusions (Fig. 3).
The microphotograph shows mild interstitial thickening (A) and intra-alveolar foamy macrophages (B) (H-E, A: x100, B: x400).
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Most air spaces were filled with a variable number of foamy alveolar macrophages (Fig. 4).
The electron microscopy demonstrates many osmiophilic lamellated bodies in the cytoplasm of foamy alveolar macrophages (uranyl acetate and lead citrate, x7,000).
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Ultra-structural findings demonstrated multiple electron dense lamellar bodies in the cytoplasm of foam cells (Fig. 5).
Follow-up chest X-ray at 15th day after withdrawal of amiodarone shows much improved infiltrations compared with those of previous films.
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Five days after withdrawal of amiodarone, clinical findings and X-ray findings were improved (Fig. 6).