Lymphocytic interstitial pneumonia

Case contributed by Dr Nur Ahida Md Ahir

Presentation

Chronic cough with whitish sputum. Associated with loss of weight and appetite

Patient Data

Age: 50
Gender: Female
X-ray

Chest X-ray (AP erect)

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.

CT

CECT thorax in lung window

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.

X-ray

CXR (PA) on follow up

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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Case information

rID: 51003
Case created: 1st Feb 2017
Last edited: 5th Feb 2017
System: Chest
Inclusion in quiz mode: Included

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