Figures
- Figure 1.
a) Chest radiograph showing bilateral coarse interstitial shadowing. b) High-resolution computed tomography scan of the chest. The image is degraded by movement due to patient dyspnoea. The thickened interlobular septae is suggestive of interstitial lung disease.
- Figure 2.
Tumour thrombi are seen in lymphatic vessels surrounding a) pulmonary arteries and bronchi (arrows) and b) underneath the pleura (*). Haematoxylin and eosin stain.
Tables
- Table 1. Differential diagnoses, investigations and results
Differential diagnosis Investigation Result Bacterial LRTI BAL microscopy and culture Negative Viral LRTI BAL viral PCR and culture Negative Fungal LRTI BAL cytology and culture Negative PCP BAL cytology and PCR Negative Pulmonary TB BAL acid-fast bacilli stain and culture; Mantoux test Negative Hypersensitivity pneumonitis IgG and IgE precipitating antibodies to inhaled organic dusts Negative Connective tissue disorder Autoimmune screen Negative Sarcoidosis Serum ACE Normal Alveolar haemorrhage syndrome# ANCA, Anti-GBM and BAL-haemosiderin laden macrophages Negative Histiocytosis Bone marrow aspirate Normal Immunodeficiency Igs and HIV tests Normal Congenital or acquired cardiac abnormality Echocardiogram Normal LRTI: lower respiratory tract infection; PCP: Pneuomocystis carinii pneumonia; TB: tuberculosis; BAL: bronchoalveolar lavage; Ig: immunoglobulin; ACE: angiotensin-converting enzyme; ANCA: anti-neutrophil cytoplasmic antigen; anti-GBM: anti-glomerular basement membrane antigen. #: Goodpasture’s disease or granulomatosis with polyangiitis (Wegener's).
