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Images in Thorax
Silicone depositions: an unusual finding in the explanted and newly transplanted lungs
  1. Saskia Bos1,2,
  2. Joaquim Majo3,
  3. Wendy Funston4,
  4. Andrew J Fisher1,2,
  5. Gerard Meachery2
  1. 1 Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
  2. 2 Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  3. 3 Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  4. 4 Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  1. Correspondence to Dr Saskia Bos, Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, NE2 4HH, UK; saskia.bos{at}newcastle.ac.uk

https://doi.org/10.1136/thorax-2023-220153

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    A woman aged 45 years suffered from progressive unclassifiable interstitial lung disease (ILD) despite treatment with corticosteroids, intravenous cyclophosphamide and rituximab. Chest CT showed extensive bilateral ground glass with associated mosaic attenuation and air trapping on expiration, along with basal predominant fibrosis, volume loss and secondary bronchial dilatation (figure 1A). Examination of bronchoalveolar lavage cytology and transbronchial biopsies showed features consistent with acute neutrophilic inflammation. Thorough medical history and detailed clinical examination revealed no relevant factors other than the fact that her husband kept pigeons in the back garden. However, she never had contact with the birds or her husband’s clothing, and the birds were removed immediately after her ILD diagnosis. Autoimmune and extended myositis screening were negative, as were avian precipitants.

    Figure 1

    (A) Last chest CT before transplantation (1 month pretransplant) showing extensive bilateral ground glass opacification and associated fibrotic changes. (B) Chest CT 6 months after transplantation showing a normal lung parenchyma.

    Due to rapid progression of the disease, she underwent bilateral lung transplantation 2 years after the initial ILD diagnosis (figure 1B). Her early post-transplant period was complicated by mild …

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    Footnotes

    • Contributors SB: collected the clinical data and wrote the manuscript. JM: provided the pathology images and critically revised the manuscript. WF, AJF and GM: critically revised the manuscript.

    • Funding Following authors are supported by a research fellowship, but received no specific funding for the current manuscript: SB is funded by the Paul Corris International Clinical Research Training Scholarship. AJF is funded in part by the National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT).

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care or NHSBT. This case was presented as a poster presentation at the European Society for Organ Transplantation Congress 2023.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.