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Weekly Chest CasesArchive of Old Cases

Case No : 652 Date 2010-04-26

  • Courtesy of Ki-Nam Lee, Dong Won Kim, Bo Sung Kim. / Department of Radiology, Dong-A University Hospital.
  • Age/Sex 21 / M
  • Chief ComplaintDyspnea, cough, fever for 4 days
  • Figure 1
  • Figure 2
  • Figure 3

Initial chest PA

Diagnosis With Brief Discussion

Diagnosis
Acute eosinophilic pneumonia
Radiologic Findings
Fig. 1. Chest PA shows diffuse bilateral hazy opacities and pleural effusion.
Fig. 2. Lung setting of the chest CT scan shows smooth peribronchial interstitial and interlobular septal thickening in both lungs and ground glass attenuation and consolidation in peribronchial and peripheral portion of both lungs.
He had a history of tobacco smoking for one year. For the diagnostic work up, BAL was done. On BAL analysis, the count of eosinophils was 37%.
Figs 3. 14 days after admission. Lung setting of the chest CT scan shows 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 eosinophils 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.
Keywords
Lung, Eosinophilic lung disease,

No. of Applicants : 112

▶ Correct Answer : 56/112,  50.0%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - Osaka University , Japan Osamu Honda
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - radiologist, aditya imaging centre , India vivek patel
  • - KING KHALID UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - Institute of Chest Diseases,Calicut , India sijith raghavan
  • - Seoul St. Mary hospital , Korea (North) gyungeun Lee
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - Assam Medical College , India Pramod K.G
  • - CH Sud Rnion , Reunion jean-baptiste Noel
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
  • - SoonChunHyang univ. hospital , Korea (South) Kim Jae Hyun
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
  • - SMG-SNU boramae medical center , Korea (South) Kwang Nam Jin
  • - Saga University , Japan Ryoko Egashira
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - CHUV , Switzerland ANNE-SOPHIE KNOEPFLI
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Russia , Saudi Arabia jehad alakabani
  • - Seoul Veterans Hospital , Korea (South) Hye Sun Hwang
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - Shinchon Severance hospital , Korea (South) Hye Mi Kim
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - EKH-Berlin , Germany Michael Weber
  • - Chonbuk National University Hospital , Korea (South) Jisoo Song
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - IRSA , France jean-luc BIGOT
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - NASA SCANS , India RAKESH BHATIA
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Department of Radiology, Chonnam National University Hospital , Korea (South) Hyungjun Kim
  • - All India Institute of medical sciences , India Justin Moses
  • - chonnam national university , Korea (South) Byung Hyun Baek
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
  • - Chungnam national university hospital , Korea (South) Jeoung Eun Lee
  • - CNUH , Korea (South) Hyedoo Jung
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Min Lee
  • - Yonsei University College of Medicine Severance Hospital , Korea (South) GA RAM KIM
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - SMC , Korea (South) Jihoon Cha
  • - Chonnam National University Hospital , Korea (South) Jun Hyung Hong
  • - Chonnam national university hospital , Korea (South) Jang-hyeon Song
▶ Correct Answer as Differential Diagnosis : 17/112,  15.2%
  • - University of British Columbia , Canada Amr Ajlan
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Kangnam severance hospital , Korea (South) Song Jae Min
  • - McGill University Health Center , Canada Alexandre Semionov
  • - CHU NANCY , France, Metropolitan GREGORY LESANNE
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - care hospital , India Chary D
  • - CHRU lille , France manuel toledano
  • - Goa Medical College , India Paresh Desai
  • - IRSA Rochefort , France Viviane Pages
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - CHU Grenoble , France Fabrice Bing
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - medical , India anup kumar
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