Presentation
Mild dyspnea in a bird breeder (more than 40 years).
Patient Data
Diffuse and bilateral reticular opacities with loss of volume.
Mediastinal widening.
Prominent pulmonary artery due to pulmonary hypertension
Widespread bilateral coarse reticulations with peripheral, peribronchovascular and basal predominance.
Architectural distortion and traction bronchiectasis most marked in the lower lobes?
Mosaic attenuation most likely due to air trapping.
Calcific foci.
Bilateral small mediastinal lymph nodes, some partially calcified.
Dilation of right heart chambers and proximal pulmonary arteries suggests pulmonary hypertension.
Case Discussion
The following features favor a diagnosis of fibrotic hypersensitivity pneumonitis (2020 classification):
mosaic attenuation
peribronchovascular and peripheral fibrosis
exposure to birds.
Pulmonary hypertension can complicate chronic fibrosis and calcific foci are a non-specific finding in chronic lung fibrosis. Calcification in mediastinal lymph nodes is unrelated and more likely due to latent TB.
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