Fig. 1

Representative photographs from radiographic and microscopic examination before starting nintedanib. Chest X-ray (a) and chest high resolution computed tomography (b) before starting nintedanib revealed subpleural reticular shadowing that was predominantly in the lower lobes, without honeycombing. Pathological examination of a surgical lung biopsy specimen showed subpleural fibrosis and microscopic honeycombing (c; hematoxylin and eosin stain, low-power field) with patchy distribution of dense fibrosis, fibroblastic foci (*), and normal lung (d; hematoxylin and eosin stain, high-power field). Thus, the diagnosis of idiopathic pulmonary fibrosis was confirmed