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Case 291

Surgical Pathology Case
 

CLINICAL INFORMATION

 

A 65 year-old male with clinical history of chronic obstructive pulmonary disease, hypertension, hyperlipidemia, benign prostatic hypertrophy and low back pain.  He complained of increasing shortness of breath in 2006. Both a chest x-ray and a CT scan were performed at that time and revealed diffuse interstitial thickening.  Pulmonary function tests revealed moderate restrictive lung disease (TLC 3.6 L, 52% of predicted) and moderately reduced DLCO at 47% of predicted. The bronchoalveolar lavage was submitted for fungal culture, bacterial culture and acid-fast bacillus which were all negative.  Pulmonary function tests were repeated in December of 2007 and showed worsening of his restrictive disease as well as a decrease in his DLCO (13%). He was hospitalized again in April 2009 for a suspected exacerbation of his pulmonary function.  He was placed on high dose prednisone as well as empiric antibiotic therapy with pipercillin-tazobactam and moxifloxacin.  He improved and was discharged to home.  On May 5, 2009 he again was admitted to the hospital for shortness of breath and chest pain. He developed respiratory failure and subsequently died.

     
 

GROSS DESCRIPTION

 

The lung reveals diffuse consolidation with cobblestone surface. One the section surface, the patchy consolidations are mixed with the relatively normal parenchyma. The consolidations are predominantly located under the pleural surface and within the lower lobes.

     
 
     
 
     
 
     
   
     
 
 

HE, 2

HE, 4

 
 

HE, 4

HE, 10

 
 

HE, 10

HE, 10

 
 

HE, 10

HE, 10

 
 

HE, 4

HE, 10

 
 

HE, 10

HE, 10

     
 

Click here for diagnosis and discussion.

 

Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Photo: Zenggang Pan

Discussion: Zenggang Pan