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Weekly Chest CasesArchive of Old Cases

Case No : 601 Date 2009-05-04

  • Courtesy of Soo-Youn Ham, Yu Whan Oh / Korea University Anam Hospital. Seoul, Korea
  • Age/Sex 28 / M
  • Chief ComplaintDyspnea (onset: 3 days ago), fever, myalgia (onset: 2 weeks ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Acute eosinophilic pneumonia
Radiologic Findings
Chest radiograph showed diffuse bilateral hazy opacities. Slight more prominent patchy infiltrations were noted on left upper, lower lung zones (Fig. 1). Chest CT scan was done on the next day. Non contrast enhanced chest CT scan revealed patchy GGO with interlobular septal thickening, manifesting as crazy paving appearance without zonal predominance (Fig. 2, 3). Follow up chest radiograph were taken on the 2nd day of admission (Fig. 4). Rapid progression of patchy GGOs in both lungs and increased the extent of radio-opacities. For the diagnostic work up, VATS biopsy was done. Follow up chest radiograph on the 15 days of admission (Fig. 5) reveals marked improvement of patchy GGOs in both lung fields.
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 of duration; hypoxemia; diffuse alveolar or mixed alveolar-interstitial opacities on chest radiographs; BAL fluid consisting of more than 25% eosinophils; absence of parasitic, fungal, or other infection; prompt and complete response to corticosteroids; and no relapse after discontinuation of corticosteroids. Peripheral blood eosinophile percentages are usually normal, although they become elevated during the subsequent clinical course. Unlike with blood eosinophils, a very high percentage of BAL eosinophils is characteristic of AEP. Patients respond rapidly to high doses of corticosteroids, usually within 24 hrs.
Characteristic CT findings in AEP patients consisted mainly of bilateral areas of ground-glass attenuation, interlobular septal thickening, thickening of bronchovascular bundles, and the presence of a pleural effusion without cardiomegaly. The most common overall anatomic distribution and zonal predominance of the abnormal CT findings were random. AEP is one of the entities of crazy paving pattern shown on CT scan. Clinical and radiologic findings of rapid progressive GGO pattern are helpful findings in the diagnosis of acute eosinophilic lung diseases
References
1. Daimon T, Johkoh T, Sumikawa H, et al. Acute eosinophilic pneumonia: Thin-section CT findings in 29 patients. Eur J Radiol. 2008:65(3);462-7
2. Jeong YJ, Kim KI, Seo IJ, et al. Eosinophilic lung diseases: a clinical, radiologic and pathologic overview. Radiographics. 2007:27(3), 617-37
Please refer to
Case 105 Case 128 Case 200 Case 260 Case 480 Case 596
Keywords
Lung, Eosinophilic lung disease,

No. of Applicants : 102

▶ Correct Answer : 16/102,  15.7%
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - Al-Hada Armed Forced Hospital , Saudi Arabia Ahmed FathiEid
  • - SMC , Korea (South) Jihoon Cha
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Hopital du SacrCoeur , Canada Abraham Bohadana
  • - CHRU Lille , France Benjamin Damarey
  • - Gumi Kangdong hospital , Korea (South) Ju Ae Kim
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - Dongguk University International Hospital , Korea (South) Ah-young Kim
  • - CH Sud Rnion , Reunion jean-baptiste Noel
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Assam Medical College , India Dr.Mrinal Singha
  • - Yonsei University college of medicine Severance Hospital , Korea (South) Hua Sun Kim
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaHun Lim
▶ Correct Answer as Differential Diagnosis : 18/102,  17.6%
  • - kims,narkatpally , India k bhaskar
  • - Institute of Chest Diseases,Calicut , India sijith raghavan
  • - hospital Sao Paulo , Brazil israel missrie
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Seoul National University Hospital , Korea (South) Kwang Nam Jin
  • - POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV
  • - Yashoda Super Speciality hospital , India Ramesh Pandey
  • - National Taiwan University Hospital , Taiwan Chin-Chung Shu
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - IRSA , France jean BIGOT
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - NASA SCANS , India RAKESH BHATIA
  • - McGill University Health Center , Canada Alexandre Semionov
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
▶ Semi-Correct Answer : 2/102,  2.0%
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Kangnam Sacred Heart Hospital , Korea (South) Jaewon Kim
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