A Patient Presenting with Bilateral Lung Lesions, Pleural Effusion, and Proteinuria
Figure 2
(a) Initial contrast enhanced CT reveals a mass-like lesion with hypoattenuated area in the left costophrenic angle. Pleural effusion is also noted in the left side. (b) Initial CT. Lung window scan reveals the mass-like lesion in the left costophrenic angle. Nodular lesions are also visible bilaterally. (c) Follow-up CT. Lung window settings, at the same level eight months later, show a nodule in the left costophrenic angle. The parenchymal nodules have disappeared. (d) Mild, diffuse, nonhomogeneous thickening of capillary basal membrane with rare micro-vacuolar degeneration of the basal membrane (Silver, ×400). (e) CT-guided lung biopsy shows a core of alveolar parenchyma in which there is intra-alveolar organisation associated with a non-specific chronic inflammatory cell infiltrate. In addition, there are areas of basophilic necrosis containing neutrophilic and fibrinoid debris. Occasional histiocytic giant cells are noted within the inflammatory cell infiltrate, although no definitive coalescent granuloma is seen. EVG staining shows that this neutrophilic/necrotic infiltrate is focally centred on the walls of the pulmonary vasculature with some loss and fragmentation of the elastin layers. (f) Non-homogeneous of IgG immunoglobulin along the capillary basal membrane walls exhibiting granular or pseudolinear distribution (IF, ×400).
