Case 244

 A seventy nine-year-old male presented in our hospital with a referring letter, saying further examination of pulmonary infection required since pulmonary shadow worsened despite of cease of medicines for rheumatoid arthritis. At first, drug-induced pneumonitis was suspected. But the pulmonary function was worsened than before. In the past, he smoke cigarettes 40/per day until age 45. He underwent coronary bypass at age 53, aortic aneurysm repair at age 72. He got rheumatoid arthritis at age 76. Laboratory test revealed PO2 66.5 mmHg, PH 7.47, BNP 328.7 pg/mL, white blood cells 13100/mm3, lymphocytes 82.8%, lymphocytes 8.1%, CRP 20.2 mg/dL, ALP 130 U/L, KL6 433 U/mL.
 He took chest CT for further investigation.

What is your imaging diagnosis ?

1.　Cardiac failure

2.　Bacillus pneumonia

3.　Cryptogenic organizing pneumonia

4.　Nonspecific interstitial pneumonia

5.　Usual interstitial pneumonia

answer

2021.9.21