PMC9996347_01
Compared to the chest radiograph results obtained at the beginning of pembrolizumab treatment (A), the radiograph results obtained at admission (B) show hyperinflation in the right lower field. Compared with the image obtained just before pembrolizumab use (C), the chest inspiratory computed tomography image at the time of the BOS diagnosis shows reduced vascular caliber and lung density in the right lower lobe and dilated airways in the both lower lobes (D).
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Compared to the findings at the beginning of pembrolizumab treatment (Fig. 1A), chest radiography showed hyperinflation in the right lower field (Fig. 1B). Compared to the images obtained just before pembrolizumab use (Fig. 1C), chest inspiratory high-resolution computed tomography (CT) showed reduced vascular caliber and lung density in the right lower lobe and bronchial dilatation in the bilateral lower lobes (Fig. 1D).
Chest expiratory computed tomography (CT) image shows decreased lung field density in the right lower lobe compared with the right middle lobe (A). Similar to the inspiratory CT results, bronchial dilatation was observed in the lower lobes of both lungs (B).
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Expiratory CT showed decreased lung field density in the right lower lobe compared with that in the right middle lobe (Fig. 2A) and dilated peripheral bronchi in the bilateral lower lobes (Fig. 2B).
The flow-volume curve 13 years before bronchiolitis obliterans syndrome (BOS) was diagnosed (3 years after right lower lobectomy) (A) and at the time of the BOS diagnosis (B). Expiratory flow limitations were observed at the time of the BOS diagnosis.
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Pulmonary function tests revealed a new restrictive and obstructive disorder (Table 1), and the flow-volume curve showed expiratory flow limitations (Fig. 3B).