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A 53-year-old man had presented to a nearby hospital with fever, dyspnea and multiple lymphadenopathy. Chest X-ray film and computed tomography had shown expanded airspace consolidations with air broncograms and surrounding ground-glass opacities in bilateral lung fields. Because his respiratory status had gradually worsened, he was transferred to our hospital and placed on the ventilator. Bronchoalveolar lavage were performed, showing abnormal lymphocytes which indicated infiltration of malignant lymphoma. Furthermore, a biopsy of the left inguinal lymph node revealed T-cell lymphoma. We finally diagnosed his pulmonary lesions as involvement of peripheral T-cell lymphoma unspecified in consideration of immunohistochemical estimation. Pulmonary involvement of malignant lymphoma is thought to be relatively uncommon. Therefore, this is considered an extremely rare case showing extensively spreading airspace consolidations and surrounding ground-glass opacities of bilateral lung fields caused by the infiltration of malignant cells along with lymphoid tissues. Because these radiological findings may indicate a severe status of lymphoma, it is necessary to diagnose and treat them immediately. From this point of view, we report this case with useful information concerning differential radiological diagnosis.

A 71-year-old woman was admitted to our hospital four times because of high fever and dyspnea from September to November in 2007. We treated her with antibiotics on her first two admissions. HOwever, we suspected hypersensitivity pneumonitis on the third admission because she suffered from fever and dyspnea soon after she had been discharged and returned home. She recovered only with the oxygen therapy on the last two admissions. Computed tomography of the chest showed early phase localized consolidation but changed to ground-glass opacities spreading over the entire lung field later during her third and fourth admissions. Bronchial alveolar lavage showed increases in total cell count, lymphocytes and IgA of pigeon-dropping extracts' and budgerigar-dropping extracts. TBLB showed epithelioid cell granulomas without caseous necrosis and alveolar septal inflammation. Inhalation challenge test using freeze-dried pigeon-dropping extracts was positive, therefore we finally established a diagnosis of acute bird related hypersensitivity pneumonitis. This is apparently the first report of acute bird-related hypersensitivity pneumonitis showing localized consolidation initially and later changing to diffuse ground-glass opacities. These radiological observations are significant in considering the onset and the progression of this disease.

A 58-year-old man was admitted with complaints of pain in the right upper right side of the chest. Chest radiography and computed tomography (CT) revealed a cavitary lesion in the right upper lobe. A CT-guided percutaneous lung biopsy and transbronchial lung biopsy of this lesion did not yield a definitive diagnosis; therefore, we performed video assisted thoracic surgery (VATS). We also investigated various types of mycosis because he had several records of overseas travel. At a later day, the histoplasma immunodiffusion test showed positive results. We finally diagnosed pulmonary histoplasmosis based on the clinical course, CT and radiographic images and serological tests. Voriconazole improved the patient's subjective symptoms and laboratory findings. A positive reaction was obtained for anti-human T-cell leukemia virus type 1 (HTLV-1) antibody and the HTLV-1 carrier, confirming his immunodeficiency disorder. We raised the possibility that the development of pulmonary histoplasmosis might be associated with the HTLV-1 carrier.