Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Acute eosinophilic pneumonia
- Radiologic Findings
- Fig. 1. Chest PA shows diffuse bilateral hazy opacities and pleural effusion.
Fig. 2. Lung setting of the chest CT scan shows smooth peribronchial interstitial and interlobular septal thickening in both lungs and ground glass attenuation and consolidation in peribronchial and peripheral portion of both lungs.
He had a history of tobacco smoking for one year. For the diagnostic work up, BAL was done. On BAL analysis, the count of eosinophils was 37%.
Figs 3. 14 days after admission. Lung setting of the chest CT scan shows marked improvement of patchy GGOs in both lung fields.
- Brief Review
- 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.
Characteristic CT findings in AEP patients consisted mainly of bilateral areas of ground-glass attenuation, interlobular septal thickening, thickening of bronchovascular bundles, and the presence of a pleural effusion without cardiomegaly. The most common overall anatomic distribution and zonal predominance of the abnormal CT findings were random. AEP is one of the entities of crazy paving pattern shown on CT scan. Clinical and radiologic findings of rapid progressive GGO pattern are helpful findings in the diagnosis of acute eosinophilic lung diseases
- 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,