Presentation
Chronic cough with whitish sputum. Associated with loss of weight and appetite
Patient Data
Multiple patches of alveolar opacities of varies sizes in both lung fields. Confluence of alveolar opacities noted at right lower zone forms a largest lung mass.
No mediastinal widening.
Heart is normal.
Both costophrenic angle are obliterates by the soft tissue shadows from outer part.
No obvious bone lesions.
Impression:
Chest radiograph findings raises few possibilities, differential diagnosis are multiple pulmonary metastases (possible primary is lung and breast), lymphoma, bronchoalveolar carcinoma, Wegener's granulomatosis.
Multiple ill defined lung nodules with surrounding ground glass opacities, fairly homogenous and varies sizes scattered in both lung.
The largest is in right lower lobe and associated with air bronchogram/consolidation and collapse seen within measuring 5.9 cm x 5.0 cm.
One of the nodule in right upper lobe has spiculated margin. No cavitating nodules seen.
Shotty mediastinal nodes. No hilar lymphadenopathies.
In this case, lung biopsy under CT guidance was performed because unable to exclude primary lung carcinoma of the right upper lobe nodule which has spiculated margin.
However HPE of the biopsied lung tissue is interstitial lymphoid pneumonia.
Marked improvement chest radiograph findings, previously seen multiple ill defined alveolar opacities are reducing in size.
No pleural effusion.
Case Discussion
In this case, lung biopsy under CT guidance was performed because unable to exclude primary lung carcinoma of the right upper lobe nodule which has spiculated margin.
However HPE of the biopsied lung tissue is interstitial lymphoid pneumonia.
After treatment, follow up CXR showed marked improvement of the findings.
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