case_images: PMC6887804_01
case_images: 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.
case_images: 10.1177_2324709619890945-fig1.jpg
case_images: PMC6887804_01_10.1177_2324709619890945-fig1.jpg
case_images: fig1-2324709619890945
case_images: 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).
case_images: 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).
case_images: 10.1177_2324709619890945-fig2.jpg
case_images: PMC6887804_01_10.1177_2324709619890945-fig2.jpg
case_images: fig2-2324709619890945
case_images: 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.