Volume 155, Issue 3, Pages e69-e74 (March 2019)

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Volume 155, Issue 3, Pages e69-e74 (March 2019) A 54-Year-Old Man Presenting With Progressive Dyspnea and Interstitial Lung Abnormalities Lisa Huang, BA, Sunkaru Touray, MB ChB, MSc, Ali Akalin, MD, Sumera Ahmad, MBBS CHEST Volume 155, Issue 3, Pages e69-e74 (March 2019) DOI: 10.1016/j.chest.2018.07.039 Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 1 Chest radiograph showing bilateral diffuse reticular opacities. CHEST 2019 155, e69-e74DOI: (10.1016/j.chest.2018.07.039) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 2 A, B, Representative images of chest CT scan demonstrating bilateral ground glass opacities with areas of mosaic attenuation. CHEST 2019 155, e69-e74DOI: (10.1016/j.chest.2018.07.039) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 3 Pulmonary function tests. CHEST 2019 155, e69-e74DOI: (10.1016/j.chest.2018.07.039) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 4 A, B, Surgical wedge lung biopsy from patient showing respiratory bronchiolitis-like areas with pigmented (smoker’s) macrophages within the respiratory bronchioles and adjacent alveolar spaces (arrows). There is significant peribronchiolar and alveolar septal fibrosis, arguing against a diagnosis of respiratory bronchiolitis interstitial lung disease. A, Hematoxylin-eosin stain (low [40×] magnification). B, Hematoxylin-eosin stain (intermediate [100×] magnification). CHEST 2019 155, e69-e74DOI: (10.1016/j.chest.2018.07.039) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 5 A, Surgical wedge lung biopsy from patient showing severe alveolar septal fibrosis with associated irregular emphysematous change (left side) in a subpleural distribution. A portion of the pleural surface is included in the right upper portion of the pictures (Hematoxylin-eosin stain, low [20×] magnification). B, Trichrome stain (low [20×] magnification). CHEST 2019 155, e69-e74DOI: (10.1016/j.chest.2018.07.039) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 6 High (200×) magnification of surgical lung biopsy from the patient showing prominent hyalinized collagen with no or minimal inflammation and interspersed (metaplastic) smooth muscle bundles in the thickened alveolar walls (hematoxylin-eosin stain). CHEST 2019 155, e69-e74DOI: (10.1016/j.chest.2018.07.039) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 7 A, B, Representative images of chest CT scan demonstrating bilateral areas of mosaic attenuation that partially improved after smoking cessation at follow-up 1 y later. CHEST 2019 155, e69-e74DOI: (10.1016/j.chest.2018.07.039) Copyright © 2018 American College of Chest Physicians Terms and Conditions