대한흉부영상의학회 Weekly Chest Cases

Case No : 369 Date 2004-11-20

Courtesy of Seo-Hyun Kwak, M.D., Kyung Soo Lee, M.D. / Samsung Medical Cneter, Seoul, Korea
Age/Sex 28 / F
Chief ComplaintCough and fever

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Diagnosis With Brief Discussion

Diagnosis: Chronic eosinophilic pneumonia
Radiologic Findings: HRCT scan of young female patient shows patchy areas of consolidations and ground-glass opacities in both lower lobes.

Her blood eosinophilc was 61 % of WBC, and bronchoscopic alveolar lavage revealed 70% of eosinophils. Transbroncial lung biopsy revealed chronic inflammation.

The findings are consistent with Chronic Eosinophilic Pneumonia or BOOP (bronchiolitis obliterans organizing pneumonia).

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).
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 : 30

▶ Correct Answer : 3/30, 10.0%

- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Social Security Hospital, Ankara, Turkey Meric Tuzun

▶ Semi-Correct Answer : 16/30, 53.3%

- ASL Bologna Ospedale, Maggiore, Italy Marcellino Burzi
- CH lyon sud, France Xavier Riviere
- CHU Nancy-Brabois, France Denis Regent
- CIM Saint Dizier, France JC Leclerc
- Dong-A University Hospital, Korea Ki-Nam Lee
- Govt. Medical College, Vadodara , India Vijay Vaidya
- Hangang sacred heart hospital, Korea Young-Jae Kim
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Leeds General Infirmary, UK Girish Raghunathan
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- Marien Hospital, Hamm, Germany Davis Chiramel
- Nancy, France Julien Mathias
- Naples, Ospedale Monaldi, Italy Gaetano Rea
- National Taiwan University Hospital, Taiwan Lin Sheng-Hsiang
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 369 Date 2004-11-20

Discussion

No. of Applicants : 30