Ground glass infiltrates

clinical-practice-essay

 

 

 

The ground glass infilitrates were caused by alveolarseptal amyloidosis.  The CT showed a uniformity of ground glass infiltrates, without a mosaic pattern.  The pathology images above include H&E, congo red and crystal violet stains which are typically used to confirm the diagnosis.  The fibrils were also  birefringent but this could not be photographed.  These were samples obtained by transbronchial biopsy.

 This case was used as a clinical vignette for the 2nd year medical students.  Above is the paper written by Nicholas Braus (click on the clinical-practice-essay icon) which is an excellent review of the pathophysiology of this disorder.  I invite you to read it.

Air in the pleural space

 

 

 

This patient is a 67 year old female who had a chronic right pleural effusion.  A thoracentesis in March did not reveal a cause.  She presented in May to HH with a pain in her left chest and increased sputum production for 2 weeks. A CT scan was done.  What do you think was responsible for the air in the pleural space?

Diffuse Ground glass infiltrates

This is a 57 year old black female who had been a smoker but stopped 1 yr ago . She complained of increasing shortness of breath over 1 year.  She had undergone PFT’s that showed reduced FVC (59%) predicted and FEV1 (72% predicted).  Her total lung capacity was 71 % predicted.  She was unable to do a diffusion capacity.  The intial chest radiograph was read as normal.  Representative images from her CT scan are above

Do you think this is an abnormal scan? Would you perform a diagnositic procedure? If abnormal, suggest a diagnosis compatible with the CT scan.