Answer of December 1998

Clinical History:

M/66. Flu-like illness with dyspnoea for 1 week, fever, unproductive cough. Rapid deterioration and died after 3 days.

Figure 1 CXR
Figure 2 CXR close-up right lower zone
Figure 3 CXR 2 days later

What is your diagnosis?

                            Figure 1                                                                         Figure 2

                            Figure 3                                                                        Figure 4

Diagnosis:

IDIOPATHIC FIBROSING ALVEOLITIS WITH BOOP

Discussion:

Figure 1 & 2 CXR showed bilateral lower zone reticulo-nodular shadows with honeycomb appearance.

Figure 3 CXR showed increase shadows in mid zones.

Figure 4 Post-mortem finding of interstitial fibrosis in right middle and both lower lobes. Areas of consolidation in upper lobes with histological changes of bronchiolitis obliterans with organising pneumonia (BOOP)