Radiology: Volume 263: Number 3-June 2012
Amie Y. Lee, MD J. David Godwin, MD Sudhakar N. J. Pipavath, MD
History
A 70-year-old woman was referred to the pulmonology clinic for progressive dyspnea on exertion over 15 years, with acceleration in the past year. The cause of her symptoms was unknown, and empirical treatment with inhaled bron-chodilators and oral prednisone helped only slightly. In the past 3-4 months, she developed chest pain on exertion. She had a 25-pack-year smoking history, but she had quit smoking 30 years ago. She had no known history of lung disease, malignancy, or connective tissue disorder. She denied any past exposure to birds or environmental fibrogenic agents. She had no cough, fever, or weight loss. There were bibasilar crackles at auscultation.
Her symptoms of pain initially suggested angina. However, coronary angiography revealed no coronary artery disease. Echocardiography revealed mild pulmonary hypertension. pH monitoring showed no gastroesophageal reflux. Pulmonary function testing revealed decreased ratio of forced expiratory volume in 1 second to forced vital capacity (55% of that predicted) and decreased diffusing capacity of the lung for carbon monoxide (39% of that predicted). Laboratory test results, including complete blood count and measurement of electrolyte, creatinine, and blood urea nitrogen levels, were unremarkable.
Frontal radiography and thin-section computed tomography (CT) were performed.