The Common Vein

• Symptoms 4 years ago
  • never smoker
    • past medical history of
      • DM2, HTN,
      • CAD s/p MI (3 stents, ~12 years ago).
    • Chest CT – Chronic HP
      • Rx Steroids
      • lung transplant on 3/31/2023.

Inspiration Expiration

Timeline

Symptoms started in 2020/2021 (subacute and hard to pinpoint)

3 years ago

started on high dose prednisone

1 year ago

eval: started O2 3lpm with exertion

 BAL with 217 nucleated cells, CD4:Cd8 0.39, lymphocytes 19%

Started cellcept , diarrhea every other day or so

 

• typical hypersensitivity pneumonitis
  • coarse reticulation and minimal honeycombing in a random axial distribution with no zonal predominance
  • evidence of small airway disease
• compatible with hypersensitivity pneumonitis
  • variable pattern and/or distribution of lung fibrosis:
    • basal and subpleural predominance
    • upper zone predominance
    • central or peribronchovascular predominance
  • fibrotic ground-glass attenuation seen alone or in association with small airway disease
• indeterminate for hypersensitivity pneumonitis
  • usual interstitial pneumonia (UIP) pattern
  • nonspecific interstitial pneumonia (NSIP) pattern
  • organizing pneumonia-like pattern
  • truly indeterminate findings

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