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68 year old male presents with Dyspnea on exertion for the past 3 years. He complains of a dry cough and has a 50 pack year smoking history but quit 8 years ago. Past medical history is significant for coronary artery disease and BPH. Home medications include aspirin, atenolol and simvastatin. Vitals are  BP of 118/67 mmHg, heart rate 88 beats/min, respiratory rate 20 breaths/min, SaO2 94% at rest, decreasing to86% after ambulating 300 ft (91 m). His lung examination shows normal percussion and expansion. There are Velcro-like crackles at both bases, and they are distributed halfway through both lung fields. No wheezing was noted. Cardiovascular examination is normal. Digital clubbing is present. A chest CT is performed and is shown below. He is referred for surgical lung biopsy. Which statement below is most typical of the pathology seen in this disease?

A. Dense amorphous fluid within the alveoli diffusely that stains positive with periodic acid–Schiff stain

B. Destruction of alveoli with resultant emphysematous areas, predominantly in the upper lobes

C. Diffuse alveolar damage

D. Formation of noncaseating granulomas

E. Heterogeneous collagen deposition with fibroblast foci and honeycombing

Alright guys, here is the Friday Teaser for this week. Please put a quick reason for your answer. Winner will be announced Monday morning 8:00 am. Let me know if having any technical issues.winner will win a $15 gift certificate.Looking foward to your responses.Have a lovely weekend 🙂

4 Responses

  1. Gaurav Goyal

    Likely secondary to IPF. IPF is usually seen in patients with advanced age and the HRCT usually shows interstitial thickening with some honey combing as well.
    The pathologic features in the lung biopsy show scattered foci of fibroblast proliferation and honeycombing.

  2. Vamsi Krishna Chilluru

    Likely 2/2 UIP. UIP incidence increases substantially with advancing age. CT shows temporal heterogeneity of fibrosis characterized by scattered fibroblastic foci in the background of dense acellular collagen, and architectural alteration due to chronic scarring or honeycomb change. Coomon causes include smoking, gastroesophageal reflux disease, occupational exposure to wood and various other occupation-related dusts, Epstein-Barr virus, and hepatitis C virus.

  3. Osama Elsallabi

    IPF, age,presentations, physical finding (clubbing, crackles),CT finding, typical pathology Heterogeneous collagen deposition with fibroblast foci and honeycombing.

So, what do you think?


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