case_images: PMC11273703_01
case_images: Chest X-ray showing consolidation in the apical segment of the right upper lobe with diffuse reticular interstitial infiltrate in both upper lobes, no rib lesions identified.
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case_images: A chest radiograph showed alveolar opacities in the right lung's upper lobe and a reticular interstitial pattern in both lungs (Figure 1).
case_images: Computed tomography of the chest where an increase in attenuation is identified in A, B, C due to the presence of consolidations of central distribution in the upper lobes. In D, E, F, ground glass infiltrates and thickening of intralobular and interlobular septa are seen that form a "cobblestone" pattern of peripheral distribution.
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case_images: This revealed consolidations in a central distribution in the upper lobes associated with ground-glass opacities and thickening of the intralobular and the anterior lobular septum of the periphery of upper lobes compatible with a "crazy-paving pattern" suggestive of a possible infiltrative process (Figure 2).
case_images: Computed tomography, window for mediastinum. Lymph nodes are found at station 2R (A) and 4R (B, C) measuring 12 mm in the short axis. Non-displaced fractures of the third and fourth left costal arches. No lytic or blastic lesions were observed in the bone structures studied.
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case_images: Other findings were atelectasis of the lateral basal segment of the right lower lobe, adenopathy at station 2R and 4R in the mediastinum (Figure 3), and 2 undisplaced fractures of the left third and fourth ribs without lytic or blast lesions.
case_images: (A) Chest X-ray showing diffuse alveolar compromise pattern with condensation of both upper lobes, with progression of infiltrates compared with previous images. (B) Decreased infiltrates in both upper lobes, mild diffuse interstitial infiltrate persists, no pleural effusion, monitoring elements, and subclavian catheter can be seen.
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case_images: Given the risk of ventilatory failure, he was transferred to the intensive care unit (ICU), where a chest X-ray was taken, evidencing the progression of infiltrates compared with previous images (Figure 4A). An additional chest X-ray was performed, evidencing decreased infiltrates (Figure 4B).
case_images: (A and B) H&E staining (4x) shows respiratory mucosa and lung parenchyma with alteration of its architecture; acute inflammatory process, hyaline membrane, and fibrin are recognized. (C and D) H&E staining (40x) shows inflammation predominantly polymorphonuclear cellularity with occasional lymphocytes and eosinophils within alveolar lumens with the presence of accompanying fibrin. (E and F) Movat staining (10x and 4x) shows altered lung architecture, with alveolar lumens filled with fibrin, hyaline membrane, and acute inflammation with a predominance of polymorphonuclear cells.
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case_images: It was negative for malignancy, granulomas, or vasculitis (Figure 5).