Case history
Case history #1
A 48-year-old school teacher develops a flu-like illness with low-grade fever, mild cough, and generalised malaise. Physical examination shows bilateral end-inspiratory crackles. The chest x-ray shows bilateral patchy infiltrates. A 10-day course of antibiotics does not improve the symptoms, and the antibiotic is changed to a fluoroquinolone. Shortness of breath develops, and the high-resolution chest computed tomography (CT) scan shows bilateral ground glass opacities with air bronchograms, some triangular in shape. The vital capacity is decreased to 72% predicted, the FEV1/FVC ratio is normal at 81%, and the diffusing capacity is decreased to 58% predicted.
Case history #2
A 60-year-old man with a 70 pack year history of smoking goes for low dose chest CT as part of his lung cancer screening. Chest CT shows a 4 cm x 3 cm right lower lobe mass in a subpleural location. On history, the patient reports having a 'walking pneumonia' 4 months earlier which was treated by his family doctor with doxycycline for 7 days and albuterol inhaler for wheezing. He denies cough, fever, sputum or weight loss. He is back to his baseline exercise tolerance, walking half a mile with mild wheezing at the end but rapid recovery not requiring inhaler therapy. He had an initial chest x-ray at the diagnosis of pneumonia but felt well after antibiotics and has not followed with his family doctor. PET scan showed uptake in the right lower lobe mass only with a standard uptake value (SUV) of 3.1. The patient is referred for a transthoracic biopsy.
Use of this content is subject to our disclaimer