Combined pulmonary fibrosis and emphysema
70 year old patient with long history of dyspnea, cough and expectoration. Patient is a heavy smoker for 40 years.
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Bilateral panlobular and paraseptal emphysematous changes with subpleural blebs
and bullae formation are noted. Bilateral coarsening of the pulmonary interstitium showing thickening of the interlobular septae with honeycombing and fibrosis involving the left upper lobe, basal lingula, basal middle lobe and both lower lobes' basal segments. These changes show asymmetrical distribution being more pronounced on the left side and basally.
Associated left upper lobe partial collapse is also noted. Multiple pathologically enlarged bilateral hilar and mediastinal lymph nodes are seen at pre-vascular, retrocaval, aorto-pulmonary window and subcarinal locations. Right upper lobe posterior segment calcified pulmonary nodule and retrocaval calcified lymph node are seen indicative of an old granulomatous infection.