1. Clinical History Locke 908061085: 55 yo male past medical history of hypothyroidism presents with increasing dyspnea. Patient was treated with several courses of antibiotics and steroids. However over the course of two months, patient’s overall respiratory status deteriorated with resultant respiratory failure requiring intubation and despite treatment patient expired. Patient underwent bronchoscopy which showed normal mucosa. A VATS procedure with wedge lung biopsies was also completed. Results of the biopsy are shown along with CT scans.

2. Traction Bronchiectasis

3. Diffuse Ground Glass

5. Lung Biopsy

6. Hyalinization of alveolar wall Note paucity of inflammatory cells and distortion of normal alveolar structure

7. Acute Interstitial Pneumonitis (Hamman-Rich Syndrome) is a rapidly progress disease process. Patients often present with unexplained dyspnea. Case reports have associated AIP with several chemotherapeutic agents and carbamazepine. AIP is characterized radiographically by diffuse interstitial infiltrates and traction bronchiectasis. The pathologic evaluation will always reveal evidence of diffuse alveolar damage. Treatment modalities include immunomodulation with steroids, however refractory disease is the most common. The long term survival of patients with AIP is poor, with a mean survival survival time from onset of symptoms to death of 26 days. OF NOTE: In this specific case, there is also pathologic evidence of usual interstitial pneumonitis with heterogeniety of fibrosis and fibroblastic foci.