Histologic changes: In image A, a respiratory bronchiole (B) has an adjacent lymphoid aggregate between it and the artery (A). The surrounding alveolar spaces are filled with pale-staining, foamy macrophages that help to account for the ground-glass appearance on HRCT. These lipid-filled macrophages are indicative of poor clearance that occurs with inflammation. Note again the widening of alveolar walls by the alveolitis.

A

A Giemsa stain (B) shows a bronchiole with a granuloma in the wall. Note the lack of erosion of the epithelium and the lack of goblet cell metaplasia, neither of which is common in this disease.

B

Clinical summaryImage 5

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