Case 698 -- A 55 year-old male with recurrent spontaneous pneumothoraces

Contributed by Christopher Griffith, MD and Larry Nichols, M.D.


This 55 year-old white male had chronic obstructive pulmonary disease, cor pulmonale and left heart failure with a left ventricular ejection fraction of 30%. He had a 48 pack-year smoking history and a remote history of IV cocaine abuse. Prior to his death the patient suffered from recurrent spontaneous pneumothoraces.


At autopsy the patient's lungs showed bilateral severe emphysema obscured by superimposed consolidation. Extensive areas of consolidation were distributed throughout both lungs and were tan with black pigmented macules (figure 1). The pulmonary arteries were dilated. The combined lung weight was 1490 grams (normal up to 1050 grams).


Histologic sections of the lungs showed deposition of foreign material with associated multinucleated foreign body giant cell reaction and extensive fibrosis, with confluent fibrosis in some areas (figures 2 and 3). The foreign material was polarizable (figures 4 and 5) and was deposited in a perivascular and occasionally intravascular distribution (figures 6 and 7). This same foreign material was found in sections of the liver, spleen, bone marrow and lymph nodes (not shown).


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