Chronic Pulmonary Thromboembolism Pathologically Showing Homogeneous Cellular Alveolitis
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概要
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A 60-year-old man was admitted to our hospital complaining of general malaise. Examination of arterial blood gases on room air revealed hypoxia. Pulmonary function test showed restrictive abnormality. Chest high-resolution CT showed diffuse mosaic attenuation without evident pulmonary artery abnormality on contrast chest CT. Based on these findings, interstitial pneumonia or chronic pulmonary thromboembolism was suspected. The findings of bronchoalveolar lavage revealed 4.4×105 cells/mL, including 89.6% macrophages, 9.4% lymphocytes, and 1.0% neutrophils. TBLB showed marked alveolitis. Moreover video-assisted thoracoscopic surgical biopsy was performed. Biopsies of the lung specimen showed focal infarct with surrounding mild mononuclear cell infiltrates (homogenous cellular alveolitis). 99mTc pulmonary perfusion and 81mKr ventilation scintigraphy showed V/Q mismatch. Furthermore, pulmonary angiography also revealed inadequate artery flow corresponding to the mismatch area of scintigraphy. Collagen vascular diseases and abnormality of coagulation factors were not detected. Multiple perfusion defects persisted for more than 6 months. Thus, finally the patient was diagnosed with chronic pulmonary thromboembolism, pathologically showing homogenous cellular alveolitis.
著者
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Chida Kingo
Department Of Pathology Iwata City Hospital
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Kobayashi Shigeru
Deparment Of Oral Anatomy Kyushu Dental College
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Hayakawa Hiroshi
Departmennt Of Pediatrics Mejirodai Campus University Of Tokyo
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Suda Takafumi
Department Of Respiratory Medicine Hamamatsu University School Of Medicine
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Miwa Seiichi
Department of Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Japan
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Shirai Masahiro
Department of Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Japan
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Kaida Yusuke
Department of Respiratory Medicine, Hamamatsu University School of Medicine, Japan
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