144Lu ILD Question Fibrosing Hypersensitivity Pneumonitis

79 year old female

Dyspnea

70F Dyspnea10 months ago
70F Dyspnea
    • CT PA  (Expiration
      • GGO’s
        • pulmonary edema
        • small airway disease
Study performed in expiration
Air trapping
Moaic Attenuation
  • 9 months ago
    • PFTs-
      FEV1 1.79 (96%)
      FVC 2.36 (95%)
      FEV1/FVC 1.0
      FEF25-75 89%, BDR 61% (false-elevated due to low FVC?)
      TLC 88%
      RV 73%
      FRC not measured
      ERV 55%
      DLCO 82%
      VA not measured
      DLCO/VA 148%
      Flow volume loop normal
      IC/VC >85%
  • 7 months ago
    • Hi Res
      • Small airway disease
        • basilar airway thickening
        • bronchiolectasis
        • air trapping
        • GGO’s
        • reticular changes
7 months ago
Basilar small airway disease, ground glass , reticular changes and bronchiolectasis, mosaic attenuation
7 months ago
Basilar small airway disease, ground glass , reticular changes and bronchiolectasis, mosaic attenuation
7 months ago
Basilar small airway disease, ground glass , reticular changes and bronchiolectasis, mosaic attenuation
7 months ago
Basilar small airway disease, ground glass , reticular changes and bronchiolectasis, mosaic attenuation
7 months ago
Centrilobular nodule
7 months ago
reticular changes
bronchiolectasis
Expiration
Air trapping not significantly different from inspiration image
    • Bronchoscopy
      • Normal Airways
    • Echo Normal
  • Elevated ESR 46

CT 3 months ago

Persistent but improved areas of groundglass opacification, air
trapping and mild dependent subpleural reticulations. Differential
includes small airways/small vessel disease and hypersensitivity
pneumonitis.

3 months ago
Improved but persistent GGO reticular changes and bronchiolectasis
3 months ago
Improved but persistent GGO reticular changes and bronchiolectasis
3 months ago
Improved but persistent GGO reticular changes and bronchiolectasis
3 months ago
Improved but persistent GGO reticular changes and bronchiolectasis

Path

1 month ago

RIGHT LOWER LOBE LUNG CRYOBIOPSY
Airway-centered fibrosis, peribronchiolar metaplasia, and mild chronic inflammation with occasional giant cell.
No lymphoid aggregates, germinal centers, or dominant plasmacytosis seen (lymphocytes > plasma cells).
No acute inflammation or foreign material observed.

Note: The pattern of inflammation raises the histologic differential of fibrotic hypersensitivity pneumonitis, however other airway-centered fibrosing disorders could also be considered. Clinical and radiologic correlation is advised. Exclusion of UIP
among other ILD’s cannot be entirely excluded due to sampling method.