Atypical CT/X-ray imaging manifestation, including
Single, or multiple, or extensive subpleural grid-like or honeycomb-like thickening of interlobular septum, thickening of the bronchial wall, and tortuous and thick strand-like opacity. Several patchy consolidations, occasionally with a small amount pleural effusion or enlargement of mediastinal lymph nodes, can be seen (Fig. 4: 6 cases, 7.2% in a total of 83 cases). This is mostly seen in the elderly.
Fig. 4 Atypical CT / X-ray imaging manifestation (case 1). An 83 years old female with fever for 4 days (maximum temperature of 38.8 ℃), cough, chills, sore throat, dry cough for 1 week, chest tightness and shortness of breath aggravating for 1 week. Laboratory test: normal white blood cells (4.6 × 109/L), normal neutrophil percentage (65.8%), decreased lymphocytes percentage (19.9%). Imaging examination: a and b showed diffuse interlobular septum thickening in both lungs to form a grid opacity, thickening of bronchial wall, and consolidation in the left sublobal lung. c showed diffused grid-like opacities in both lungs, especially in the left lung
(2) Single or multiple solid nodules or consolidated nodules in the center of lobule, surrounded by ground-glass opacities (Fig. 5: 5 cases, 6.2% in a total of 83 cases).
Fig. 5 Atypical CT / X-ray imaging manifestation (case 2). A 56 years old female with fever for 3 days. Laboratory test: decreased total protein (54.0 g/L),decreased albumin (35.5 g/L),decreased globulin (18.5 g/L), normal white blood cells (4.87 × 109/L), decreased lymphocytes percentage (10.1%), decreased lymphocytes (0.49 × 109/ L), decreased eosinophil count (0 × 109/L)), decreased eosinophil count percentage (0%). Imaging examination: a showed two consolidation nodulesat the center of the lateral segment of middle lobe of the right lung which was surrounded by ground-glass opacities; b showed patchy ground-glass opacity in the anterior segment of the right upper lung with patchy consolidation lesions in it; c showed patchy ground-glass opacities in both lungs with patchy consolidation lesions in it. d showed patchy consolidation in the ground-glass opacities in the middle lobe and dorsal segment of lower lobe of right lung