Imaging Diagnosis of Interstitial Pneumonia with Emphysema (Combined Pulmonary Fibrosis and Emphysema)
Figure 3
Diffuse interstitial pneumonia (UIP pattern), emphysema with fibrosis. The patient underwent right lower lobectomy for lung cancer of the right lower lobe. (a) HRCT of the right upper lobe shows severe centrilobular emphysema. (b) HRCT of the right lower lobe shows slight ground glass opacity including several thick-walled cyst. (c) HRCT of basilar region shows subpleural ground glass opacity and reticular opacity in the subpleural region: radiologically consistent with UIP pattern. There are some relatively thick-walled cysts in subpleural region; however, no evidence of honeycombing. (d) Pathologic specimen (H&E staining) shows centrilobular and paraseptal emphysema with collagen type fibrosis. (e) Pathologic specimen shows dense centrilobular collagen-type fibrosis, associated with centrilobular emphysema. (f) Pathologic specimen shows cystic lesion in the acinus with destruction of alveoli and dense perilobular and peribronchiolar fibrosis. Normal alveoli adjacent to the cystic lesion. (g) Pathologic specimen shows patchy subpleural and intralobular fibrosis with alternating emphysematous, nonfibrotic area. Note fibroblastic foci (arrows). Sharp border between advanced fibrosis and normally appeared tissue suggests UIP pattern.
