Presentation
1 week of increasing shortness of breath on exertion. no infective symptoms.
Patient Data
Diffuse reticular shadowing throughout both lung fields. Peribronchial cuffing is seen, predominantly in the perihilar region.
Changes were acute compared to a recent chest CT.
Prior recent CT Chest had been unremarkable except for the solid nodule just anterior to the right inferior pulmonary vein which has now markedly decreased in size (consistent with the response of lung metastases to immunotherapy).
There are new, innumerable, centrilobular micronodules (tree-in-bud appearance) throughout both lungs. There is bronchial wall thickening and bronchiolar dilatation.
There are small bilateral pleural effusions.
Case Discussion
The patient was on a clinical study that included the administration of nivolumab for the treatment of metastatic melanoma.
Imaging findings, along with clinical history, were consistent with bronchiolitis secondary to immune checkpoint inhibitor therapy.
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