대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 698 Date 2011-03-16

  • Courtesy of Hwan-Seok Yong, Eun-Young Kang. / Korea University Guro Hospital
  • Age/Sex 22 / M
  • Chief ComplaintDyspnea (onset: 3 days ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Fig.1

Diagnosis With Brief Discussion

Diagnosis
Acute eosinophilic pneumonia.
Radiologic Findings
He had a history of recent onset tobacco smoking for 2 weeks. For the diagnostic work up, BAL was done. On BAL analysis, the count of eosinophils was 45%.
Chest PA (Fig 1) shows diffuse bilateral hazy opacities and pleural effusion.
Lung setting of the chest CT images (Fig 2-4) show smooth peribronchial interstitial and interlobular septal thickening in both lungs and ground glass attenuation and consolidation in peribronchial and peripheral portion of both lungs.
Mediastinal setting of chest CT images (Fig 5-6) show small amount of bilateral pleural effusion and mild LN enlargement in mediastinum and subcarinal area.
Brief Review
Acute eosinophilic pneumonia (AEP) represents a clinical entity that is distinct from other idiopathic eosinophilic lung diseases. Diagnostic criteria include acute febrile illness of less than 5 days of duration; hypoxemia; diffuse alveolar or mixed alveolar-interstitial opacities on chest radiographs; BAL fluid consisting of more than 25% eosinophils; absence of parasitic, fungal, or other infection; prompt and complete response to corticosteroids; and no relapse after discontinuation of corticosteroids. Peripheral blood eosinophils percentages are usually normal, although they become elevated during the subsequent clinical course. Unlike with blood eosinophils, a very high percentage of BAL eosinophils is characteristic of AEP. Patients respond rapidly to high doses of corticosteroids, usually within 24 hrs.

Typical radiographic finding is diffuse bilateral reticular opacities with or without patchy consolidation and pleural effusion. On chest CT, it shows findings of bilateral patchy area of ground glass opacity and consolidation accompanied with poorly defined nodules and smooth interlobular septal thickening. Pleural effusion is commonly combined.

The radiologic differential diagnosis for AEP includes hydrostatic pulmonary edema, adult respiratory distress syndrome or acute interstitial pneumonia, and atypical bacterial or viral pneumonia. However, developing a clinicoradiologic differential diagnosis for AEP is often difficult because initial peripheral blood eosinophil counts are usually normal.
References
1. Daimon T, Johkoh T, Sumikawa H, et al. Acute eosinophilic pneumonia: Thin-section CT findings in 29 patients. Eur J Radiol. 2008:65(3);462-7.

2. Jeong YJ, Kim KI, Seo IJ, et al. Eosinophilic lung diseases: a clinical, radiologic and pathologic overview. Radiographics. 2007:27(3), 617-37.
Keywords
Lung, Eosinophilic lung disease,

No. of Applicants : 106

▶ Correct Answer : 74/106,  69.8%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - radiologist, aditya imaging centre , India vivek patel
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - McGill University , Canada Ben Smith
  • - Assam Medical college , India samudra borah
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Kobe City Medical Center General Hospital , Japan Hitomi Nagano
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - Seoul National University Hospital , Korea (South) Yeo Goon Kim
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - soonchunhyang bucheon hospital , Korea (South) Jeong Sun Hye
  • - Okayama University , Japan Akihiro Tada
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Severance hospital , Korea (South) Saerom Hong
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
  • - Chonnam National University , Korea (South) se hee Jung
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
  • - Chonnam national university hospital , Korea (South) Yunhong Yoon
  • - chonnam national university , Korea (South) Byung Hyun Baek
  • - CNUH , Korea (South) Seoin Jeong
  • - Chonnam university hospital , Korea (South) LEE JI HYUN
  • - Iwate Medical University , Japan Akio Akahane
  • - Chonnam National University Hwasoon Hospiral , Korea (South) You Ri Choi
  • - NTUH , Taiwan Kuei-pin Chung
  • - University of British Columbia , Canada Amr Ajlan
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - chungbuk uni. hospital , Korea (South) JY Ahn
  • - Catholic medical center , Korea (South) hyuna kim
  • - Saga University , Japan Ryoko Egashira
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Okayama university , Japan Mayu Uka
  • - SMC , Korea (South) Yi Kyung Kim
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Severance Hospital , Korea (South) Kyung-eun Kim
  • - Shiga university of medical science , Japan Akitoshi Inoue
  • - kobe city general hospital , Japan rintaro hashimoto
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Gifu Chuo Hospital , Japan Yo Kaneko
  • - Chungnam National University hospital, Korea , Korea (South) sunkyoung you
  • - Chonbuk National University Hospital , Korea (South) Jisoo Song
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Himchan Hospital , Korea (South) Kwon Hyoung Kim
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - Bupyeong Serim Hospital , Korea (South) Hee Seok Choi
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - TELERADIOLOGY SOLUTIONS, BANGALORE , India ZAHOOR AHMED
  • - HSC , Brazil Diogo Pinheiro
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Teleradiology , India Savith Kumar
  • - IRSA , France jean-luc BIGOT
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Saint Malo , France jean-baptiste Noel
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - NASA SCANS , India RAKESH BHATIA
  • - All India Institute of medical sciences , India Justin Moses
  • - CNUH , Korea (South) Hyedoo Jung
  • - KUMC ansan , Korea (South) kihwan kim
  • - Yonsei University College of Medicine, Severance Hospital , Korea (South) Hyung Jin Rhee
  • - A.P.Chest hospital ,hyderabad , India k bhaskar
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - St Mary hospital , Korea (South) Chaehun Lim
▶ Correct Answer as Differential Diagnosis : 8/106,  7.5%
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun JunYeh
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - McGill University Health Center , Canada Alexandre Semionov
  • - royal melbourne hospital , Australia kimchi kings
  • - Montreal , Canada D J
  • - Zaid Alsheriti hospital- Alsweida , Syria jehad alakabani
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
▶ Semi-Correct Answer : 1/106,  0.9%
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

This website is optimized for IE 10 and above.