Presentation
Smoker 68 pack years. Bird owner - budgies. Rule out alveolitis/fibrosis .
Patient Data
Reticulonodular change in both lungs (right more than left) and consistent with an alveolitis.
Panlobar reticular change and centrilobular nodularity with a lower lobe predominance, worse in the right lung. Minor traction bronchiectasis.
Superadded areas of confluence ground glass change, such as in the posterior aspect of the apical segment of the right lower lobe.
Lung volumes are maintained.
No significant lymphadenopathy.
6 mth FU after Rx with steroids
Panlobar fibrosis with a lower lobe predominance, mild airway distortion and reticular changes, worse in the right lung. Peripheral sparing.
The ground glass change has resolved since the prior CT.
Lung volumes are maintained.
No significant lymphadenopathy.
Case Discussion
The initial CT appearances should fibrosis and superadded pneumonitis. i.e. Acute on chronic extrinsic allergic alveolitis.
The second study after a response to steroids demonstrates the successful treatment of the acute phase (pneumonitis) with the chronic fibrotic component remaining.
Given the strong history of exposure to birds and a positive antigen for pigeon budgerigar and poultry the diagnosis of pigeon fanciers lung was given.