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British Journal of Radiology (2005) 78, 762-766
© 2005 British Institute of Radiology
doi: 10.1259/bjr/95651807
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Fatal acute exacerbation of usual interstitial pneumonia in ulcerative colitis

K Marten, MD 1 F Fend, MD 2 H Hautmann, MD 3 M Kremer, MD 2 E J Rummeny, MD 1 and C Engelke, MD 1

Departments of 1 Radiology, 2 Pathology and 3 Pneumology, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 München, Germany



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  		Figure 1. Initial chest CT (5 mm section thickness) from July 2002 showing panacinar and paraseptal emphysema affecting the upper and middle lobes and the lingula (arrows). Note additional mild right-sided subpleural interlobular and intralobular interstitial thickening (arrowheads). Traction bronchiectasis and honeycombing are absent.

 


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  		Figure 2. Chest radiograph from July 2003. Note the bilateral lung hyperinflation indicating pulmonary emphysema. There is no evidence of interstitial lung disease.

 


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  		Figure 3. Chest radiograph from October 2003 showing bilateral lower and mid-zone reticular opacities consistent with major interstitial lung disease (arrows) in comparison with the previous chest radiograph (Figure 2Go).

 


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  		Figure 4. High-resolution CT in the last week of October demonstrated typical features of usual interstitial pneumonia with severe architectural distortion including honeycombing (arrowheads), massive traction bronchiectasis and bronchiolectasis (arrows). In addition, multifocal areas of ground glass opacification were present, suggestive of diffuse alveolar damage (asterisks).

 


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  		Figure 5. Photomicrographs illustrating the most striking histological features of the usual interstitial pneumonia (Haematoxylin & Eosin stain, x 300): (a) Remodelled fibrotic cystic air spaces (arrowhead) are lined by bronchiolar epithelium containing mucinous debris and inflammatory cells (arrow). (b) A focus of organizing pneumonitis (asterisks) composed of spindled fibroblasts dispersed in pale oedematous-appearing stroma. (c) Area of diffuse alveolar damage with hyaline membranes (arrow) superimposed on a background of fibrotic lung parenchyma. (d) Prominent smooth muscle hyperplasia (arrowheads) in remodelled pulmonary septae.

 




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