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Weekly Chest CasesArchive of Old Cases

Case No : 367 Date 2004-11-06

  • Courtesy of Ki Nam Kim, M.D., Ki-Nam Lee, M.D., M.D. / Dong-A University Hospital, Pusan,
  • Age/Sex 41 / M
  • Chief ComplaintCoughing, sputum for 1 month
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Eosinophilic granuloma (Histiocytosis X)
Radiologic Findings
Chest radiograph shows multiple small ring opacities and reticulonodular opacities in both lung fields, which are evenly distributed from upper lung to costophrenic angles.
Initial HRCT scans show multiple cavitary nodules and thin- and thick-walled cysts: some have smooth margins, others have irregular margins. These are seen in peribronchial or peribronchiolar in location, and neither in zonal predominance, nor sparing of lung bases. The intervening lung parenchyma appears normal without evidence of fibrosis.
F/U HRCT after 5 months without therapy show marked decreased in number, size of cavitated nodules, but still Diagnosis of eosinophilic granuloma (histiocytosis X) was made by thoracoscopic wedge resection of left lower lobe just after initial HRCT. Pathologic specimen at a low magnification(002) shows interstitial thickening caused by a cellular infiltrate and mild fibrosis. A magnified view(001) of the infiltrate shows it to be composed of scattered, bilobed eosinophils and numerous histiocytes with irregularly shaped, vesicular nuclei that are focally grooved.
Brief Review
??We want to focus on the clinical and pathologic findings of histiocytosis X.
References
1. Webb WR, Muller NL, Naidich DP. High-resolution CT of the lung. 3rd. Lippincott Williams & Wilkins, 2001:421-429

2. MW Brauner, P Grenier, MM Mouelhi, D Mompoint, and S Lenoir. Pulmonary histiocytosis X: evaluation with high-resolution CT. Radiology 1989; 172: 255-258.

3. AD Moore, JD Godwin, NL Muller, DP Naidich, SP Hammar, DL Buschman, JE Takasugi, and CR de Carvalho Pulmonary histiocytosis X: comparison of radiographic and CT findings. Radiology 1989; 172: 249-254.
Keywords
Lung, Interstitial lung disease, LCH, smoking related ILD,

No. of Applicants : 42

▶ Correct Answer : 22/42,  52.4%
  • - Asan Medical Center, Korea Eun Jin Chae
  • - ASL BOLOGNA, Maggiore Hospital , Italy Marcellino Burzi
  • - Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
  • - CH lyon sud, France Xavier Riviere
  • - Chosun University Hospital, Korea Hyung Woo Oh
  • - CHU Nancy-Brabois, France Denis Regent
  • - Govt. Medical College, Gujarat , India Vijay Vaidyaz
  • - Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
  • - Hangang sacred heart hospital, Korea Young-Jae Kim
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Hanyang University Hospital, Seoul, Korea Son Youl Lee
  • - IRCCS Ospedale S.Luca, Milano, Italy Filippo Casolo
  • - Jikei University of Medicine, Japan Shigeki Misumi
  • - Kyungpook National University Hospital, Korea Shin Kyung-Min
  • - Maggiore Hospital, Bologna, Italy Marcellino Burzi
  • - Mallinckrodt Institute of Radiology, USA Jin Mo Goo
  • - Marien Hospital, Hamm, Germany Davis Chiramel
  • - Naples, Ospedale Monaldi, Italy Gaetano Rea
  • - National Taiwan University Hospital, Taiwan Tan Che Kim
  • - OBP Clinic, Moscow Lepikhina Dasha
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
▶ Semi-Correct Answer : 3/42,  7.1%
  • - CIM Saint Dizier, France JC Leclerc
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - National Taiwan University Hospital, Taipei, Taiwan Wei-Lun Liu
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