Histologic Changes

Small muscular arteries, as shown here to the right of a bronchiole, had marked narrowing by irregular fibrocellular, intimal thickening. No plexiform lesions were present. Also, in this case no thrombi were found. The elastic arteries showed atherosclerosis, consistent with pulmonary hypertension.

This interlobular septum (between large arrows) has some collapsed lung between it and the pleura (at left). The septum is markedly widened and collagenized. It contains dilated lymphatics, one of which shows a valve (small arrow). The alveolar parenchyma to the right of the septum shows focal collapse. This septal thickening corresponds to Kerley B lines on radiographs.

Acute septal widening occurs with edema, but the widening indicated by the collagenous scar above suggests chronic venous vascular obstruction in the heart, mediastinum, or pulmonary veins.

A section of the subpleural scar shown grossly had no associated vascular congestion or hemosiderin. It is probably a healed infarct related to the arterial narrowing. The slit-like spaces in one honeycombed space (arrow) represent a cholesterol granuloma composed of empty clefts left by dissolved lipoid material released from uncleared cellular debris.

What is the patient's diagnosis?

Clinical summary Discussion

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