THOMAS V. COLBY
Mayo Clinic
Scottsdale, AZ
There are two fragments on the slide and they come from two different patients. The piece that shows
the more dramatic changes is from a 38-year-old woman with increasing dyspnea, decreased diffusing
capacity, and severe obstruction functionally. Radiologic studies showed emphysema and cystic change.
The patient was a never smoker.
The other second tissue is from a woman who presented at age 31
with hemoptysis and cough. She developed progressive dyspnea and two years later underwent single
lung transplant from a male donor. The explanted lung showed the same features as were present in the
other specimen on your slide. One year after transplantation, she developed evidence of bronchiolitis
obliterans and a year after that, she had refractory pneumothoraces and other complications that could
not be managed and she died. This lung tissue is from the allograft taken at the autopsy.
MARIE-CHRISTINE AUBRY
Mayo Clinic
Rochester, MN
A 68 year-old man was investigated for recent persistent chest pain. He also complained of
progressive shortness of breath and dry cough for several months. He had no significant past medical
or familial history. He was a current smoker of 90 pack-years. His pulmonary function test showed
mild restriction. Chest X-ray and CT Scan were performed and showed a spiculated peripheral mass in
the left lower lobe. Bilateral fibrotic infiltrates were also noted. He underwent a left lower
lobectomy, which was complicated by prolonged ventilator dependence, bronchopleural fistula and
infection of muscle flap. He was eventually dismissed to hospice care and died 6 months following his
surgery.
ANDREW CHURG
University of British Columbia
Vancouver, BC, Canada
A 34 yo male presented with a several month history of increasing shortness of breath. The shortness
of breath was not precipitated by an acute illness. He was a nonsmoker. He had no pets at home.
There was no recent travel history. He had worked for 10 years grinding saw blades at a small
factory. CT scan showed diffuse ground glass infiltrates with small centrilobular nodules. Pulmonary
function tests demonstrated a restrictive pattern with reduced diffusing capacity. A thoracoscopic
lung biopsy was performed.
ANNA-LUISE KATZENSTEIN
SUNY Upstate Medical Center
Syracuse, NY
This 30 year old man presented with increasing shortness of breath and cough over one week. He had a
history of pneumonia treated with antibiotics three months previously. On admission, his hematocrit
was 60 and hemoglobin 20. His p02 on room air was 50. Chest radiographs showed bilateral ground
glass infiltrates. He was initially treated with antibiotics but worsened and developed respiratory
failure requiring mechanical ventilation. An open lung biopsy was performed.
(Case contributed
by Dr. Robin Bideau, Louisville, KY).
JEFFREY L. MYERS
Mayo Clinic
Rochester, MN
A 21 year old woman who recently quit smoking was self-referred for further evaluation of progressive
shortness of breath due to diffuse interstitial lung disease. Transbronchial lung biopsy performed
elsewhere was reported as "suspicious for" or "consistent with" Langerhans cell histiocytosis. While
in an outpatient waiting area she developed increased back pain and resting sinus tachycardia. She
was urgently admitted to a hospital cardiology service for further care and monitoring. Chest x-ray
demonstrated left tension pneumothorax with mediastinal shift associated with diffuse interstitial
infiltrates. A chest tube was placed. Cardiac evaluation demonstrated sinus tachycardia without
evidence of intrinsic myocardial dysfunction. On the second hospital day she underwent video assisted
thoracoscopic surgery with wedge lung biopsy and talc pleurodesis.
