Tuberc Respir Dis.  2006 Sep;61(3):294-298. 10.4046/trd.2006.61.3.294.

Diffuse Nodular Interstitial Infiltrations with Bilateral Hilar Lymphadenopathy

• Yoon JH
• Yeo CD
• Shin EJ
• Song SH
• Kim CH
• Moon HS
• Song JS
• Park SH

• KMID: 1970271
• DOI: http://doi.org/10.4046/trd.2006.61.3.294

Abstract

Lymphocytic interstitial pneumonia(LIP) is an uncommon condition in which the alveolar septa and extra-alveolar interstitial space are markedly expanded by small lymphocytes, plasma cells and histiocytes. Chest radiographs generally show nonspecific patterns with the most common pattern showing bibasilar reticular or reticulonodular infiltrates. Hilar or mediastinal lymphadenopathy and pleural effusions are usually absent. We encountered a 42-year-old female patient who was admitted to hospital because of exertional dyspnea and palpitation. The chest X-ray showed an enlarged bilateral hilar shadow and diffusely increased bronchovascular markings in both lung fields. The chest CT showed diffuse nodular infiltrations with mild septal thickening and combined patchy ground glass opacity in both lungs, and conglomerated mediastinal and bilateral hilar lymphadenopathy. A diagnosis of LIP was made from the tissue pathology taken by a thoracoscopic lung biopsy. The patient showed clinical and radiographic improvement after 3 months of treatment with prednisolone. We report a case of LIP presenting as diffuse nodular interstitial infiltrations with multiple mediastinal and bilateral hilar lymphadenopathy.

Keyword

Lymphocytic interstitial pneumonia; Diffuse nodular infiltrations; Bilateral hilar lymphadenopathy

MeSH Terms

Adult
Biopsy
Diagnosis
Dyspnea
Female
Glass
Histiocytes
Humans
Lip
Lung
Lymphatic Diseases*
Lymphocytes
Pathology
Plasma Cells
Pleural Effusion
Prednisolone
Radiography, Thoracic
Thorax
Tomography, X-Ray Computed
Prednisolone

Figure

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  Figure 1 Chest PA shows somewhat enlarged bilateral hilar shadow and diffusely increased bronchovascular markings in both lungs.

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  Figure 2 Chest CT shows diffuse bronchovascular bundle thickening in both parahilar regions, and a 4mm sized nodule in anterior segment of RUL(A). Diffuse nodular infiltration with mild septal thickening and combined patchy ground glass opacities in both lungs, with some tiny cystic change in both lung apices are noted(B).

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  Figure 3 Chest CT shows conglomerated mediastinal and bilateral hilar lymphadenopathy(A) and several tiny lymphadenopathy in lower neck and axilla bilaterally(B).

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  Figure 4 Follow-up chest PA(A) shows decreased bilateral hilar enlargement and slightly cleared diffuse interstitial infiltrations in both lungs. Follow-up chest CT shows markedly improved pulmonary nodular infiltration, ground glass opacities, and mild intra and interlobular septal thickening(B) and markedly decreased size of the mediastinal and bilateral hilar lymph nodes(C).

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  Figure 5 Small round inflammatory cells composed of lymphocytes and plasma cells infiltrate alveolar septa and extra-alveolar interstitial space forming lymphoid follicles with follicle center.(A: ×100, B:×400, H&E stain)

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