Pulmonary Pathology Case Presentations

Pulmonary Pathology Case

Presentations

Kevin O. Leslie. MD

Mayo Clinic Arizona

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

PulmCase 1

Clinical history

A 65-year-old woman presents with a one year history of bilateral lung lesions. The lesions are said to wax and wane in size and distribution. There is mild hilar and mediastinal adenopathy. Chest imaging reveals multiple lung nodules of variable size, the largest measures 1.5 cm.

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

Case 1-1

Case 1-2

Case 1-3

Case 1-4

Case 1-5

Case 1-6

Case 1-7

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

What is the pattern?

1. Acute injury

2. Fibrosis

3. Cellular infiltrates

4. Alveolar filling

5. Nodules

6. Minimal changes

What is your “favored” diagnosis?

1. Lymphoid interstitial pneumonia (LIP)

2. Wegener granulomatosis

3. Intraparenchymal lymph node

4. Lymphomatoid granulomatosis (LYG)

5. Focal lymphoid hyperplasia

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

PulmCase 2

Clinical history

A 18-year-old high school student, captain of the

junior varsity track and field team, presents with one

week of rapidly progressive shortness of breath

accompanied by night sweats and fever. She is

hospitalized and requires intubation.

Chest imaging shows bilateral asymmetrical

ground-glass opacities.

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

What is the pattern?

1. Acute injury

2. Fibrosis

3. Cellular infiltrates

4. Alveolar filling

5. Nodules

6. Minimal changes

What is your “favored” diagnosis?

1. Acute granulomatous infection

2. Bronchiolitis obliterans organising pneumonia (BOOP)

3. Eosinophilic pneumonia

4. Acute viral pneumonitis

5. Cryptogenic organizing pneumonia

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

PulmCase 3

A Pattern-Based Approach to Diffuse Parenchymal Lung

Disease

Clinical history

A 47-year-old man presents with unexplained

persistent cough. Constitutional symptoms

are mild, with minimal shortness of breath on

exertion. Chest imaging shows sharply

defined areas of ground-glass attenuation.

Case 4-1

Case 4-4

Case 4-7

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

What is the pattern?

1. Acute injury

2. Fibrosis

3. Cellular infiltrates

4. Alveolar filling

5. Nodules

6. Minimal changes

What is your “favored”

diagnosis?

1. Pulmonary oedema

2. Pneumocystis pneumonia

3. Alveolar proteinosis

4. Pneumoconiosis (Aluminosis)

5. Drug toxicity

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

PulmCase 4

Clinical history

A 52-year-old woman presents with progressive shortness of breath accompanied by non-productive cough. The patient feels her pulmonary problems began following a bout of apparent community acquired pneumonia 1 year earlier.

Chest imaging reveals patchy ground-glass opacities alternating with zones of normal appearing lung. Expiratory views appear to enhance infiltrates.

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

Inspiratory CT

Expiratory CT

Case 5-1

Case 5-3

Case 5-4

Case 5-5

Case 5-7

Case 5-6

Case 5-8

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

What is the pattern?

1. Acute injury

2. Fibrosis

3. Cellular infiltrates

4. Alveolar filling

5. Nodules

6. Minimal changes

What is your “favored”

diagnosis?

1. Pulmonary hypertension

2. Chronic small airways disease

3. Lymphangitic carcinoma

4. Lymphangioleiomyomatosis (LAM)

5. Sampling error

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

PulmCase 5

Clinical history

A 44-year-old woman presents with a four

month history of cough accompanied by

shortness of breath on exertion.

Chest imaging shows miliary small

centrolobular nodules involving the mid and

upper lung zones, bilaterally.

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

Case 6-1

Case 6-10

Case 6-3

Case 6-11

Case 6-4

Case 6-5

Case 6-6

Case 6-7

Case 6-9

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

What is the pattern?

1. Acute injury

2. Fibrosis

3. Cellular infiltrates

4. Alveolar filling

5. Nodules

6. Minimal changes

What is your “favored”

diagnosis?

1. Sarcoidosis

2. Atypical mycobacterial infection

3. Hypersensitivity pneumonia

4. IV drug abuse

5. Cryptogenic organising pneumonia (COP)

A Pattern-Based Approach to Diffuse Parenchymal Lung

Disease

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

PulmCase 6

Clinical history

A 36-year-old woman presents for follow-up

screening one year after being diagnosed and

treated for invasive ductal adenocarcinoma of the

right breast.

Imaging reveals miliary bilateral nodules involving

the mid and upper lung zones.

A Pattern-Based Approach to Diffuse Parenchymal Lung

Disease

Case 8-2

Case 8-3

Case 8-4

Case 8-5

Case 8-6

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

What is the pattern?

1. Acute injury

2. Fibrosis

3. Cellular infiltrates

4. Alveolar filling

5. Nodules

6. Minimal changes

What is your “favored” diagnosis

1. Metastatic carcinoma

2. Mixed dust pneumoconiosis

3. Langerhans cell histiocytosis

4. Sarcoidosis

5. Capillary hemangiomatosis

A Pattern-Based Approach to Diffuse Parenchymal Lung

Disease

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

PulmCase 8

Clinical history

A 49-year-old woman with inflammatory bowel disease presents with progressive shortness of breath accompanied by fatigue. Four weeks before admission to the hospital she had begun a new regimen for treatment of her inflammatory bowel disease.

Chest imaging shows bilateral asymmetrical ground-glass infiltrates involving all lung zones. The patient's respiratory condition deteriorates and she requires mechanical ventilation.

A Pattern-Based Approach to Diffuse Parenchymal Lung

Disease

PulmCase 8

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease

What is the pattern?

1. Acute injury

2. Fibrosis

3. Cellular infiltrates

4. Alveolar filling

5. Nodules

6. Minimal changes

What is your “favored” diagnosis?

1. Diffuse alveolar damage (DAD)

2. Organising pneumonia (OP)

3. Cryptogenic organising pneumonia (COP)

4. Nonspecific interstitial pneumonia (NSIP)

5. Usual interstitial pneumonia (UIP)

A Pattern-Based Approach to Diffuse Parenchymal

Lung Disease