Acute interstitial pneumonitis

Case contributed by Dr Hani Salam

Diagnosis almost certain

Presentation

Progressive shortness of breath.

Patient Data

Age: 65 years

Gender: Female

From the case: Acute interstitial pneumonitis

X-ray

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Frontal

Low lung volume with bi-basilar dependent atelectasis/consolidation.

From the case: Acute interstitial pneumonitis

Axial lung window

Bi-basilar and dependent ground glass opacities, interlobular septal thickening and mild traction broncheiactasis.

From the case: Acute interstitial pneumonitis

6 month follow up

Axial lung window

There is progression of the bi-basilar traction broncheactasis and parenchymal architectural distortion of the lung bases.

From the case: Acute interstitial pneumonitis

X-ray

One year from initial chest xray

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Frontal

Persistent low lung volume with bi-basilar atelectasis/scarring.

From the case: Acute interstitial pneumonitis

Another 6 month follow up

Axial lung window

Persistent, essentially stable, bi-basilar traction broncheiactasis and architectural distortion.

Case Discussion

This case demonstrates the typical findings of acute interstitial pneumonitis (AIP), considered a rapidly progressive interstitial disease of unknown etiology.

The disease suspicion confirmed by open lung biopsy; which demonstrates the combination of diffuse alveolar damage (DAD) along with some changes of cryptogenic organizing pneumonia (COP).