Other Findings

Intralobular Fibrosis

This centrilobular region shows a chronic constrictive, lymphocytic bronchiolitis as well as interstitial, intralobular fibrosis that radiates into the adjacent alveolar walls. Fibrosis can also involve the interlobular septa, and both contribute to the interstitial thickening of the apparent "crazy-paving" pattern on HRCT. The alveoli filled with macrophages produce the intervening ground-glass appearance.




Find the constricted bronchiole.

Find the branch of the accompanying pulmonary artery.

Note the type II cell hyperplasia.




Granulomatous Reaction

This section shows a granulomatous reaction to lipoid material in the interstitium around a small vessel. Note the empty lipoid vacuoles in the giant cells and in the surrounding connective tissue. Note also the lipoid-filled macrophages in the alveolar spaces.

The giant cells of the granuloma are of foreign body type, characterized by multiple central nuclei. In contrast, giant cells of Langhans' type, as seen in tuberculosis, have peripherally arranged nuclei.

Find the collection of foreign body giant cells with lipoid inclusions.

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Cluster of giant cells with lipoid inclusions































Constricted bronchiole with surrounding chronic inflammation and fibrosis





























Branch of pulmonary artery in bronchovascular bundle