Serum Vascular Endothelial Growth Factor D in Cystic Lung Disease

A 28-year-old nonsmoking woman was referred to the pulmonary clinic for further evaluation of shortness of breath with exertion. She had slowly progressing dyspnea over the past year and general fatigue. She did not report a history of xerostomia, keratoconjunctivitis sicca, pleural effusions, pneumothoraces, seizure, cognitive impairment, recurrent sinopulmonary infections, or previous autoimmune disease diagnosis and had no relevant family history of lung disease. Her physical examination findings were unremarkable and there was no evidence of cutaneous lesions. A high-resolution computed tomographic (CT) scan of her chest revealed diffuse thin-walled pulmonary cysts without nodules, parenchymal changes, or lymphadenopathy (Figure). Imaging of her abdomen did not show kidney lesions or abdominal masses. The patient’s serum vascular endothelial growth factor D (VEGF-D) level was elevated at 1300 pg/mL (reference range, <600 pg/mL).