Clinics in diagnostic imaging (212)

• Main Authors: Yong, Glenn Khai Wern, Kwan, Kenneth Eng Ling, Chuah, Khoon Leong, Chai, Gin Tsen
• Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
• Format: Article
• Language: English
• Published: 2022
• Subjects: Science::Medicine; Diagnostic Imaging; Pleuroparenchymal Fibroelastosis
• Online Access: https://hdl.handle.net/10356/162590
• Institution: Nanyang Technological University

A 75-year-old woman presented in 2014 with a non-resolving left lower lobe consolidation. Initial less invasive attempts at biopsy of the left lower lobe consolidation failed to obtain a definitive diagnosis, and the patient underwent a left lower lobectomy and lymph node dissection. Histology revealed adenocarcinoma with no lymphovascular invasion, and she was diagnosed with Stage IIA lung adenocarcinoma. She did not require radiotherapy and declined adjuvant chemotherapy. Upper lung changes on initial preoperative computed tomography (CT) of the thorax performed in 2014 (Fig. 1) were originally interpreted to be due to benign post-infectious scarring. The patient subsequently underwent surveillance CT of the thorax over a period of time until 2020. She had no chronic cough, sputum production or worsening exertional dyspnoea over the years. She was a non-smoker and her body mass index (BMI) was 12.6 kg/m2 on her latest review. Her oxygen saturation was 98% on room air, and physical examination revealed reduced breath sounds over the left lung, with bilateral fine crepitations. There were no signs suggestive of a connective tissue disease. An autoimmune screen comprising anti-nuclear antibody, rheumatoid factor and anti-cyclic citrullinated peptide tests was negative, and the patient was unable to produce sputum to screen for acid-fast bacilli. She held multiple jobs previously, including dishwashing, cleaning and being a kitchen helper. What do the initial CT done in 2014 (Fig. 1) and subsequent CT done in 2019 (Fig. 2) show? What is the diagnosis?