PMC6887804_01
Computed tomography scan of chest at initial presentation (A and B), and after 5 weeks (C). Images A and B demonstrate bilateral airspace disease, predominantly in lower lobes, with patchy areas of ground-glass densities in a peripheral, peribronchial, and basilar distribution that was seen at the time of presentation. Image C, taken 5 weeks after presentation, shows diffuse bilateral interstitial infiltrates and interval worsening of ground-glass opacities scattered throughout both lungs. Fibrotic changes were evolving bilaterally with more dense consolidative changes in the lung bases and an interval worsening in aeration of the upper lobes.
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Computed tomography scan of the chest at time of presentation showed bilateral airspace disease, predominantly in lower lobes, with patchy areas of ground-glass densities in a peripheral, peribronchial, and basilar distribution (Figure 1A and B). A repeat computed tomography chest scan, done 5 weeks later, showed diffuse bilateral interstitial infiltrates, interval worsening of ground-glass opacities scattered throughout both lungs, and evolving fibrotic changes bilaterally (Figure 1C).
Hematoxylin and eosin section of right wedge lung biopsy. (A) Low-magnification power (x100) and (B) high-magnification power (x200), showing mixed alveolar inflammatory infiltrate with significant eosinophilic-predominance (black arrows). (C) Low-magnification field (x100) that demonstrates multinodular organizing pneumonia with fibroblastic proliferation and subpleural dense fibrous deposition (blue arrows).
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Pathological examination of right wedge lung biopsy revealed mixed alveolar inflammatory infiltrate with significant eosinophilic-predominance, multinodular fibroblastic proliferation, and subpleural dense fibrous deposition (Figure 2), a pattern consistent with CEP and evolving organizing pneumonia.