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Weekly Chest CasesArchive of Old Cases

Case No : 281 Date 2003-03-15

  • Courtesy of Mi-Young Kim, M.D. / Inje Univerisity Ilsan Paik Hospital, Kyeonggi-do, Korea
  • Age/Sex 36 / F
  • Chief ComplaintCough, sputum for 1 month. No history of asthma
  • Figure 1
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  • Figure 3
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  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Chronic Eosinophilic Pneumonia
Radiologic Findings
Chest radiograph shows areas of consolidation in both lungs, predominantly involving peripheral area, so called 'photographic negative pulmonary edema pattern'. HRCT scans show patchy areas of consolidation in both lungs. Associated bullae in apex and small air cavities, most likely associated centrilobular emphysema, are also seen.
Her blood eosinophilc was 12 % of WBC, and bronchoscopic alveolar lavage revealed 39% of eosinophils. Transbroncial lung biopsy revealed chronic inflammation.
Chest radiograph obtained 1 month later with steroid therapy shows cleared both lungs.
Brief Review
Chronic eosinophilic pneumonia is characterized pathologically by eosinophilic and lymphocytic accumulation in the alveoli and interstitium. Interstitial fibrosis and eosinophilic abscess may be seen. Histologic features of bronchiolitis obliterans organizing pneumonia or low-grade vasculitis may also be present (1).
The symptoms are insidious and continue for at least one month before diagnosis in all patients. They include cough, fever, dyspnea, and weight loss. Peak incidence of the disease is in the fifth decade. Forty percent of patients have associated asthma. Women are more frequently involved than men (two-to-one ratio).
Chest radiograph classically shows bilateral areas of nonsegmental consolidation in a subpleural distribution. This pattern is seen in 60% of cases. Nodules with or without cavitation are present in 20 % of cases. Pleural effusions are rare and observed in less than 10% of patients (2). CT scan also shows subpleural areas of consolidation, demonstrating peripheral dominance more clearly and frequently than chest radiograph. In the early stage of the disease, consolidation is the predominant abnormality on CT, while nodules or reticular densities predominate in later stages (3). -- From Review of Case 163 --
References
1. Kim Y, Lee KS, Choi DC: The spectrum of eosinophilic lung disease: Radiologic findings. J Comput Assist Tomogr 21:920-930,1997
2. Jederlinic PJ, Sicilian L, Gaensler EA: Chronic eosinophilic pneumonia. A report of 19 cases and a review of the literature. Medicine 67:154-162,1988
3. Ebara H, Ikezoe J, Johkoh T, et al: Chronic eosinophilic pneumonia: Evolution of chest radiograms and CT features. J Comput Assist Tomogr 18:737-744,1994
Keywords
Lung, Eosinophilic lung disease,

No. of Applicants : 36

▶ Correct Answer : 24/36,  66.7%
  • - Annecy Hospital, France Gilles Genin
  • - Bharat Scans, Chennai, India R G Gopinath
  • - Chung Li Ten-Chen Hospital,Taiwan Gui-Lin Zheng
  • - Chungju Hospital Konkuk University, Korea Chang Hee Lee
  • - Dept of IM, Seoul National University Hospital, Korea Hee-Seok Lee
  • - Dept of IM, Seoul National University Hospital, Korea Changmin Choi
  • - Ewha Womans' University Hospital, Korea Sung Shine Shim
  • - GeumGang Asan Hospital, Korea Ju Youn Park
  • - Gwangmoung Seongae Hospital, Korea Jiyong Rhee
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Hanyang University Hospital, Korea Seunghun Lee
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Korean National Institute of Health, Korea Sang-Min Lee
  • - Maimonides Medical Center, New York, USA Naomi Twersky
  • - National Medical Center, Korea Sang Kyu Yang
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Prever-Centro Radiologico, Brazil Arismar Leon Pereira
  • - Samsung Medical Center, Korea Yeon Joo Jeong
  • - Seoul National University Hospital, Korea Kyung Soo Cho
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - SUN Hospital, Uiwang, Korea Ki Taek Hong
  • - Sunlin Hospital. Pohang, Korea Won Hyuk Shin
  • - Ulsan University Hospital, Korea Kwang-Won Seo
▶ Semi-Correct Answer : 12/36,  33.3%
  • - Annecy Hospital, France Stephane Hominal
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Bharat Scans, Chennai, India R K Vaheesan
  • - Bharat Scans, Tamil Nadu, India P Xavier Rajesh
  • - Capital Armed Forces Hospital, Korea Hoil Yoon
  • - CHU Nancy-Brabois, France Denis Regent
  • - Dept of IM, Seoul National University Hospital, Korea Jae-Joon Yim
  • - Ewha Hospital, Pusan, Korea Mi ok Sunwoo
  • - Kangbuk Samsung Hospital, Korea Semin Chong
  • - National Taiwan University Hospital, Taiwan Kao-Lang Liu
  • - Soroka University Medical Center, Beer-Sheva, Israel Pavel Crystal
  • - Teleradiology Solutions, Bangalore, India Sharad Bidari
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Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

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