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2015 Annual Meeting
Evening Specialty Conference - Pulmonary Pathology
Sunday, March 22, 2015 - 7:30pm to 9:30pm
CC Ballroom A
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Case title: A rare mimic of interstitial pneumonia
Clinical Summary:
  • 41-year-old woman presented with a four-year history of progressive dyspnoea.
  • Ex-smoker (around 20 pack years).
  • Past medical history: asthma, depression, psoriatic arthropathy treated in the past with methotrexate, and breast augmentation surgery in 2004. No known asbestos exposure.
  • Clinical examination showed fine bibasal crepitations with 93% oxygen saturations and no associated clubbing or cyanosis.
CT of chest 1
CT of chest 1
CT of chest 2
CT of chest 2
high power of lung
high power of lung
intermediate power of lung
intermediate power of lung
hig power of lung
hig power of lung
high power of lung
high power of lung
high power of lung
high power of lung
EVG of lung
EVG of lung
Perl's stain
Perl's stain
Case title: Unexpected finding in lobectomy specimen resected for treatment of pulmonary bleeding
Clinical Summary:

A 61 year old male had a medical history of median laparotomy for perforated appendicitis 12 years before surgical treatment for cholelithiasis with cholecystectomy (histologically no foam cells) revealing multiple adhesions. This was followed by several complications (bleeding, perforation and small bowel perforation) each treated with relaparotomy. At the intensive care unit therapy also comprised parenteral feeding (intralipid). During the second relaparotomy aspiration occurred. Patient developed ARDS, treated with mechanical ventilation with pneumothorax, sepsis treated with antibiotics and renal failure requiring dialysis. For pneumothorax drains were installed , complicated by severe bleeding.  Thoracotomy was performed under anticoagulation therapy. A drain was uncovered in the right middle lobe,  treated with lobectomy. During resection severe hypertension developed, instable ventilation requiring high ventilation pressure. 

Slide at distance from bleeding site
Slide at distance from bleeding site
overview lung close to bleeding site
overview lung close to bleeding site
high power image of alveolar walls
high power image of alveolar walls
High power RML close to bleeding site
High power RML close to bleeding site
higher power image adjacent to broncihole
higher power image adjacent to broncihole
Case title: A 55-year-old man with bilateral ground glass opacities and reticulation
Clinical Summary:

   A 55-year-old man with a history of hypertension, asthma, and 10 pack/year history of cigarette smoking presented with progressive shortness of breath over the previous 3 months, as well as fatigue, weakness, diaphoresis, and a cough productive of yellow sputum.  CT imaging of the chest showed diffuse bilateral ground glass opacities, bilateral upper lobe consolidation, and bilateral reticulation at the lung periphery, without pleural disease, pleural effusions, or masses.  The clinicoradiologic impression was fibrotic interstitial lung disease, and he was referred for open lung biopsy.










Case title: IgG4-related lung disease presenting as ILD with UIP features
Clinical Summary:

Unknown Case Presentation

 

A 62-year-old man presented with insidious onset of dry cough and dyspnea for approximately six months. He denied sputum production, hemoptysis and pleuritic chest pain. He is a never-smoker and worked in an office setting without any apparent environmental, occupational or pneumotoxic medication exposures. Physical examination was notable for bi-basilar mid-inspiratory crackles and hypopigmentation in a distribution consistent with vitiligo, raising the question of localized scleroderma, but his history and physical exam were not otherwise suggestive of underlying autoimmune diseases. Pulmonary function tests (PFTs) showed a mild restrictive pattern with a moderately decreased diffusing capacity for carbon monoxide (DLCO). High resolution computed tomography (HRCT) of the chest showed diffuse bilateral non-specific interstitial abnormalities with lower zone predominance. The patient underwent surgical lung biopsy from all three right lung lobes.

slide 1: low power view, HE
slide 1: low power view, HE
slide 2. low power view, HE
slide 2. low power view, HE
slide 3. medium power view, HE
slide 3. medium power view, HE
slide 4. thickened visceral pleura with plasma cell infiltrates, HE
slide 4. thickened visceral pleura with plasma cell infiltrates, HE
slide 5. IgG4 immunostain (400x)
slide 5. IgG4 immunostain (400x)
Clinical Summary:

The patient is a 34-year-old never smoker who works as a cook and teaches Spanish and dance.  After swimming one summer morning she noted shortness of breath and an increased heart rate which for her was quite unusual.  When symptoms did not resolve after 1.5 hours she went to the emergency room where she was noted to have wheezes.  A chest x-ray done three years previously had been normal.  A CT scan at the hospital showed innumerable small bilateral cysts with a slight lower lung predominance and apical sparing.  These were associated with areas of ground glass attenuation in the mid and lower lungs.  The experienced chest radiologist who reviewed the CTs thought that the combination of cysts and ground glass attenuation in this distribution was nonspecific and atypical for both pulmonary Langerhans’ cell histiocytosis and lymphangioleiomyomatosis.  He suggested the diagnosis of lymphocytic interstitial pneumonia.  She underwent transbronchial biopsy.