대한흉부영상의학회 Weekly Chest Cases

Case No : 929 Date 2015-08-17

Courtesy of Suyon Chang, Hye-Jeong Lee / Severance Hospital, Yonsei University College of Medicine
Age/Sex 18 / F
Chief ComplaintCough, dyspnea for one day. This patient has no past history of medico-surgical illness.

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Diagnosis With Brief Discussion

Diagnosis: Acute eosinophilic pneumonia
Radiologic Findings: Chest radiograph shows diffuse interlobular septal thickening with bilateral pleural effusion. The heart size is within normal range.
On chest CT, interlobular interstitium and bronchovascular bundles are diffusely thickened. There are multifocal subpleural and peribronchial consolidations with a small amount of bilateral pleural effusion.
Considering her young age and radiologic findings, acute eosionophilic pneumonia was suspected. The patient had 27% bronchoalveolar lavage (BAL) fluid eosinophilia. After applying corticosteroids, her symptoms and radiographic findings improved rapidly.
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, hypoxemia, and diffuse alveolar or mixed alveolar-interstitial opacities on chest radiograph.
Peripheral blood eosinophil percentages are usually normal, although they become elevated during the subsequent clinical course. BAL fluid consists of more than 25% eosinophils.
Patients respond rapidly to high doses of corticosteroids, usually within 24–48 hours.

The cause of AEP remains unknown; however, AEP-like signs and symptoms have been reported after cigarette smoking or exposure to dust or smoke from fireworks.
The principal histologic finding in AEP is diffuse alveolar damage associated with interstitial and alveolar eosinophilia.
The predominant radiographic findings of AEP are bilateral reticular densities (with or without areas of patchy consolidation) and pleural effusion. The predominant patterns of parenchymal abnormality seen at CT are bilateral patchy areas of ground-glass opacity, frequently accompanied by interlobular septal thickening and sometimes by consolidation or poorly defined nodules.
Radiologic differential diagnoses of AEP include hydrostatic pulmonary edema, adult respiratory distress syndrome or acute interstitial pneumonia, and atypical bacterial or viral pneumonia. However, as initial peripheral blood eosinophil counts are usually normal, developing a clinicoradiologic differential diagnosis for AEP is often difficult.
Please refer to: KSTR Imaging Conference 2014 Spring Case 8 ,
KSTR Imaging conference 2010 Summer Case 22 ,
KSTR Imaging conference 2009 Summer Case 5 ,
Thoracic Imaging 2008 - Korean & Japanese Film Interpretation - Case 3 ,
KSTR Imaging Conference 2007 Spring Case 9 ,
KSTR Imaging Conference 2005 Summer Case 9 ,
KSTR Imaging Conference 2005 Spring Case 4 ,
KSTR Symposium 1998 Case 3,
References: RadioGraphics 2007; 27:617–639
Keywords: Lung, Eosinophilic lung disease,

No. of Applicants : 82

▶ Correct Answer : 48/82, 58.5%

- Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
- Juntendo University Hospital , Japan Akifumi Hagiwara
- Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
- Avrasya Hospital , Turkey Murat Ulusoy
- Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
- Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Shiga University of Medical Science , Japan Akitoshi Inoue
- Tashkent Medical Academy , Uzbekistan Rustam Fayzullaev
- radiologist, aditya imaging centre , India vivek patel
- Tong young Red cross hospital , Korea (South)
- Kyoto University , Japan Akihiko Sakata
- KAUMS, kashan , Iran Ebrahim Razi
- GHICL , France manuel toledano
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
- Niigata City General Hospital , Japan Takao Kiguchi
- Okayama University Hospital , Japan Toshiyuki Komaki
- Seoul university hospital , Korea (South) Youngjin Ryu
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- CH Nevers , France Yacine El Yaagoubi
- Asan , Korea (South) Sania ALBlushi
- Kizawa Memorial Hospital , Japan Yo Kaneko
- chp st martin , France Mariotte benoit
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- Andong Medical Center , Korea (South) Dong-Ho Bang
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- CHU Poitiers , France CHAN paul
- Fortis hospital , Mohali , India Shaleen Rana
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
- IRSA LA ROCHELLE , France, Metropolitan BIGOT
- Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
- Pusan national university hospital , Korea (South) Jin Joo Kim
- Wuhan Union Hospital , China Qiguang Cheng
- IRSA La Rochelle , France Denis Chabassiere
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- University of Tsukuba Hospital , Japan Sodai Hoshiai
- okayama university , Japan numa shingo
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Himeji Red Cross Hospital , Japan Mayu Uka
- Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
- Nasaret Hospital , Korea (South) Hee Seok Choi
- CRA , Morocco Abdelhafid SBIHI
- University of Tsukuba Hospital , Japan Shioto Oda

▶ Correct Answer as Differential Diagnosis : 4/82, 4.9%

- Oita University, Faculty of Medicine , Japan Fumito Okada
- Asan Medical Center , Korea (South) Jooae Choe
- Okinawa Kyodo Hospital , Japan Shoko Iraha
- NASA SCANS , India RAKESH BHATIA

▶ Semi-Correct Answer : 6/82, 7.3%

- �stanbul , Turkey Ayhan Yilmaz
- Niigata University , Japan Atsushi Uehara
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- CHU Henri Mondor - APHP , France, Metropolitan LEGOU Francois
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- Otsu Red Cross Hospital , Japan Hirotsugu Nakai

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 929 Date 2015-08-17

Discussion

No. of Applicants : 82