Case 27--Interstitial Lung Disease

Clinical summary: A 62-year-old woman with a diagnosis of interstitial lung disease made in 1995 underwent unilateral lung transplantation on 1/12/99. There had been a gradual onset of dyspnea beginning in the early 1990s. She had smoked cigarettes (45 pack-years) but quit in 1978. There was no history of systemic illness, drug toxicity, or exposure to dusts. In the Spring of 1995, dyspnea and non-productive cough worsened and between 2/95 and 4/97, TLC dropped 2 L and VC dropped 1 L. The DLCO dropped from 15 to 5.8/ml/mn/mm Hg. In October, 1996, treatment with prednisone was followed by gradual substitution of azathioprine. CT scans worsened. An open lung biopsy was performed in 1996. She required home oxygen from mid 1997 onward. Physical examination at the time of transplantation: T 36.1° C, BP 130/64, HR 115/min. In no acute distress, she had diffuse crackles bilaterally, mild clubbing, but no edema.

Pretransplant PFTs:

Date

VC
(% pred)

RV

TLC

DLCO

FVC

FEV1

FEV1/FVC

4/22/98

1.4 L (39%)

0.7 L (33%)

2.3 L (40%)

5.4 ml/mn/
mm Hg (47%)

1.6 L (44%)

1.5 L (54%)

94%

Arterial blood gases: PaO2 47 mm Hg, PaCO2 42 mm Hg

On 1/19, during convalescence, she collapsed with pulseless electrical activity, suffered irreversible brain damage, and died 2/7.

Radiology | Image 1 | Image 2 | Image 3 | Image 4 | Discussion

Table of Contents