79 year old female

Dyspnea

• • CT PA  (Expiration
    • GGO’s
      • pulmonary edema
      • small airway disease

• 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

• • 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.

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.