대한흉부영상의학회 Weekly Chest Cases

Case No : 902 Date 2015-02-09

Courtesy of Ji Yung Choo, Da-Jung Kim, Sung-Joon Park, Ki Yeol Lee / Korea University Ansan Hospital
Age/Sex 43 / F
Chief ComplaintDyspnea, Cough, Fever, Past history of asthma

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Diagnosis With Brief Discussion

Diagnosis: Churg-Strauss syndrome
Radiologic Findings: Initial Chest radiograph shows multifocal patchy consolidation on both lungs.
On chest CT, multifocal patchy consolidations with GGO are scattered in both lungs. Small centrilobular nodules with tree-in-bud patterns and bronchial wall thickening are also seen. Multiple mediastinal LN enlargements are also seen.
On PNS water’s view radiograph, there is irregular mucoperiosteal thickening in both maxillary sinuses, suggesting chronic maxillary sinusitis. Mild GB wall thickening and pericholecystic fluid collection is noted on MRCP.
Chest radiographs had shown wax and wane patterns of multifocal consolidation and nodular opacities in both lungs in proportion to serum eosinophil count.
Surgical specimens of right middle lobe, mediastinal LN, and gallbladder show necrotizing vasculitis with eosinophils, consistent with Churg-Strauss syndrome.
Brief Review: Churg-Strauss syndrome, which is known as eosinophilic granulomatosis with polyangiitis and allergic granulomatous angiitis, is a highly variable illness. Some people have only mild symptoms, whereas others experience severe complications. Almost all patients have asthma and eosinophilia but someone also have extrapulmonary signs and symptoms.
There are no specific tests to confirm Churg-Strauss syndrome. Thus the American College of Rheumatology has established criteria for identifying Churg-Struass syndrome. The following features are consistent with a diagnosis of CSS.
- asthma
- eosinophilia of 10% white blood cell count
- migratory or transient pulmonary opacities on chest radiographs
- mononeuropathy or polyneuropathy
- paranasal sius abnormalities
- extravascular eosinophils on biopsy
Radiologic manifestations of CSS are nonspecific but may show transient, patchy, and nonsegmental consolidation or small and large nodular opacities. Ground-glass opacities and consolidation seen on high-resolution CT reflect the presence of eosinophilic pneumonia, vasculitis, and pulmonary alveolar hemorrhage. Centrilobular nodules and bronchial wall thickening also can be seen but less common features.
Treatment for Churg–Strauss syndrome includes glucocorticoids (such as prednisolone) and other immunosuppressive drugs. CSS has no cure but these treatment can usually help control symptoms.
Please refer to: KSTR Imaging Conference 2011 Summer Case 2 ,
KSTR Imaging Conference 2008 Summer Case 8,
References: - Kim, Yoon Kyung, et al. "Pulmonary involvement in Churg-Strauss syndrome: an analysis of CT, clinical, and pathologic findings." European radiology 17.12 (2007): 3157-3165.
- Greco A, Rizzo MI, De Virgilio A, Gallo A, Fusconi M, Ruoppolo G, Altissimi G, De Vincentiis M. Churg-Strauss syndrome. Autoimmunity Reviews. 2014 Dec 11; . Epub 2014 Dec 11.
- Silva CI, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A. Churg-Strauss syndrome: high resolution CT and pathologic findings. Journal of Thorac Imaging. 2005 May; 20(2):74-80.
- Jeong, Yeon Joo, et al. "Eosinophilic Lung Diseases: A Clinical, Radiologic, and Pathologic Overview 1." Radiographics 27.3 (2007): 617-637.
Keywords: Lung, Multiple organ, Vasculitis,

No. of Applicants : 71

▶ Correct Answer : 34/71, 47.9%

- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- isfahan university of medical sciences , Iran johary s
- University of British Columbia , Canada Amr Ajlan
- McGill University Health Center , Canada Alexandre Semionov
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
- Haeundae Paik Hospital , Korea (South)
- Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
- Shiga University of Medical Science , Japan Akitoshi Inoue
- Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Oita University, Faculty of Medicine , Japan Fumito Okada
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- University of the Ryukyus , Japan Nanae Tsuchiya
- Niigata University , Japan Atsushi Uehara
- Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
- Kyoto University , Japan Akihiko Sakata
- CHU Poitiers , France CHAN paul
- Seoul National University Hospital , Korea (South) Hyoung-In Choi
- Severance hospital , Korea (South) SeungHyun Park
- Ibaraki-gazou-shindan , Japan Shoichi Katoh
- university of montreal , Canada Andrei Gorgos I
- Kizawa Memorial Hospital , Japan Yo Kaneko
- CHRU Lille , France Julien Pagniez
- IRSA La Rochelle , France Denis Chabassiere
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- CLCC Rennes , France nicolas gautier
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Gifu Central Hospital , Japan Haruo Watanabe
- Chonnam national university hospital , Korea (South) INSOO JANG
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- All India Institute of medical sciences , India Justin Moses
- Medicheck health care , Korea (South) Chae Lim

▶ Correct Answer as Differential Diagnosis : 16/71, 22.5%

- Avrasya Hospital , Turkey Murat Ulusoy
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
- All India Institute of Medical Sciences , India Jitesh Ahuja
- SNUH , Korea (South) Eui Jin Hwang
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Niigata City General Hospital , Japan Takao Kiguchi
- Intermed Hospital , Mongolia Khulan Khurelsukh
- NASA SCANS , India RAKESH BHATIA
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- Okayama University Hospital , Japan Toshiyuki Komaki
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- Fukuyama City Hospital , Japan Mayu Uka
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
- VHS medical center , Korea (South) Keuntak Roh

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 902 Date 2015-02-09

Discussion

No. of Applicants : 71