Upper Lobe Pulmonary Fibrosis Associated With High-Dose Chemotherapy Containing BCNU for Bone Marrow Transplantation James M. Parish, MD, John R. Muhm,

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Upper Lobe Pulmonary Fibrosis Associated With High-Dose Chemotherapy Containing BCNU for Bone Marrow Transplantation James M. Parish, MD, John R. Muhm, MD, Kevin O. Leslie, MD Mayo Clinic Proceedings Volume 78, Issue 5, Pages 630-634 (May 2003) DOI: 10.4065/78.5.630 Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Chest radiograph of BCNU-treated patient, showing small right apical pneumothorax, bilateral apical pleural thickening, bilateral upper lobe fibrosis, and upward retraction of both hila. The pneumothorax was not evident on a radiograph obtained 1 year earlier. Mayo Clinic Proceedings 2003 78, 630-634DOI: (10.4065/78.5.630) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Computed tomographic scans of the thorax in BCNU-treated patient, showing a small right apical pneumothorax, bilateral apical pleural thickening, and bilateral upper lobe subpleural fibrosis (top), multiple small right apical subpleural bullae (middle), and a small right pleural effusion (bottom). Mayo Clinic Proceedings 2003 78, 630-634DOI: (10.4065/78.5.630) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Photomicrographs of lung biopsy specimen from BCNU-treated patient. Upper left, Pleural and interlobular septal fibrosis with portions of the intervening parenchyma relatively spared. Delicate interstitial fibrosis is present to a variable degree throughout the sections. Some tractional dilatation of membranous bronchioles is evident. Upper right, High-magnification view showing laminated appearance of denser peripheral fibrosis interfacing with looser fibrosis beneath. P = pleural surface. Lower left, High-magnification view showing parenchymal fibrosis with associated mild chronic inflammation. Lower right, Cystic membranous bronchiole adjacent to area of fibrosis (hematoxylin-eosin, original magnification: upper left, x20; upper right, x40; lower left, x60; lower right, x40). Mayo Clinic Proceedings 2003 78, 630-634DOI: (10.4065/78.5.630) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Computed tomographic scans of the thorax in BCNU-treated patient 1 year after presentation, showing resolution of the right apical pneumothorax (left) and progression of the bilateral apical pleural thickening, bilateral subpleural fibrosis, and bilateral upper lobe fibrosis (left and right). Mayo Clinic Proceedings 2003 78, 630-634DOI: (10.4065/78.5.630) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions