Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Chronic eosinophilic pneumonia
- Radiologic Findings
- Fig 1. Chest PA shows increased peripheral parenchymal opacity in both upper lobes (Right > Left).
Figs 2-4. Axial and coronal lung window setting of the chest CT scans show nonsegmental areas of ground-glass opacity with peripheral and upper lung zone predominance.
Peripheral eosinophil count was 14900/microL and percentage of eosinophils in the bronchoalveolar lavage (BAL) fluid was 88%.
- Brief Review
- Chronic eosinophilic pneumonia is an idiopathic condition characterized by chronic and progressive clinical features and specific pathologic findings. The clinical manifestation is usually insidious, and women are more frequently affected than men. Most patients are middle aged, and approximately 50% have asthma.
Peripheral blood eosinophilia is usually mild or moderate but occasionally is severe. Blood eosinophilia is present in 90% of patients. The percentage of eosinophils in the BAL fluid is very high. Histologic examination typically shows accumulation of eosinophils and lymphocytes in the alveoli and interstitium, with interstitial fibrosis.
The imaging findings of chronic eosinophilic pneumonia are characterized by ground-glass and consolidative pulmonary opacities. A peripheral and upper lung distribution is typical and the findings have been described as the photographic negative appearance of classic central pulmonary edema. CT demonstrates typical nonsegmental areas of airspace consolidation or ground-glass opacity with peripheral predominance. CT performed more than 2 months after the onset of symptoms shows linear bandlike opacities parallel to the pleural surface.
Prompt diagnosis is crucial because the response to steroids is excellent. However, unlike in acute eosinophilic pneumonia, clinical relapse occurs in 30–60% of chronic eosinophilia cases after steroid cessation. After treatment, residual pulmonary fibrosis may be identified in some patients.
- References
- 1. Jeong YJ et al. Eosinophilic Lung Diseases: A Clinical, Radiologic, and Pathologic Overview. Radiographics 2007; 27:617– 639.
2. Adam Bernheim et al. A Review of Clinical and Imaging Findings in Eosinophilic Lung Diseases. AJR 2017; 208:1002–1010.
- Keywords
- Lung, Eosinophilic lung disease,