대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 666 Date 2010-08-02

  • Courtesy of Hye-Jeong Lee, Ji Eun Nam, Jin Hur, Young Jin Kim, Byoung Wook Choi, Kyu Ok Choe / Severance Hospital, Yonsei University Health System
  • Age/Sex 34 / F
  • Chief ComplaintDyspnea and dry cough for three months, Smoking history : Current smoker (15pyrs)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

2010-05-22

Diagnosis With Brief Discussion

Diagnosis
Subacute hypersensitivity pneumonitis
Radiologic Findings
Chest radiograph shows diffuse ill-defined nodules in both lungs.

High resolution CT demonstrates diffuse innumerable centrilobular nodules in both lungs.
Note that nodules spare the fissures and pleural surfaces.

A VATS biopsy was performed and pathologic specimens revealed the areas of interstitial inflammation and ill-defined granulomas, findings consistent with hypersensitivity pneumonitis (HP).
She is an ordinary housewife and her favorite pastime was a ceramic sculpture. Her symptoms and radiologic findings have gradually improved after initiation of corticosteroid therapy and after cessation of a ceramic sculpture.
Brief Review
Hypersensitivity pneumonitis (HP) is a diffuse granulomatous interstitial lung disease caused by inhalation of various antigenic organic particles. A high index of suspicion and meticulous acquisition of an environmental and occupational history are essential in making the diagnosis.
Lung biopsy is often necessary for confident diagnosis, and most cases of HP, whether acute or insidious, include the following four histologic features in variable amounts and combinations: cellular bronchiolitis, diffuse chronic interstitial inflammatory infiltrates (primarily consisting of lymphocytes and plasma cells), and poorly circumscribed interstitial nonnecrotizing (noncaseating) granulomas.

HP traditionally has been classified as manifesting in three phases: acute, subacute, and chronic.
Although this classification is helpful, patients often present with both subacute and chronic findings. Subacute HP is caused by intermittent or continuous exposure to low doses of antigen.
The characteristic high-resolution CT manifestations of subacute HP consist of patchy or diffuse bilateral ground-glass opacities, poorly defined small centrilobular nodules, and lobular areas of decreased attenuation and vascularity on inspiratory images and of air trapping on expiratory
images. The ground-glass opacities primarily reflect the presence of diffuse lymphocytic interstitial pneumonitis; minor degrees of organizing pneumonia, when present, also can contribute to this appearance. The poorly defined centrilobular nodules may be caused by cellular bronchiolitis, the predominantly peribronchiolar distribution of interstitial pneumonitis, or focal areas of organizing pneumonia. The lobular areas of decreased attenuation and air trapping are presumably caused by small-airway obstruction by cellular bronchiolitis or, less commonly, by constrictive bronchiolitis. In the appropriate clinical setting these findings strongly suggest the diagnosis.
References
1. Silva CI, Churg A, Muller NL. Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings. AJR Am J Roentgenol 2007;188(2):334-344.
2. Hirschmann JV, Pipavath SN, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics 2009;29(7):1921-1938.
Keywords
Lung, Interstitial lung disease, HP, ILD,

No. of Applicants : 128

▶ Correct Answer : 23/128,  18.0%
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - Catholic medical center , Korea (South) hyuna kim
  • - Hopital de Pau , France Mathieu Cannella
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Severance Hospital , Korea (South) Kyung-eun Kim
  • - University of British Columbia , Canada Amr Ajlan
  • - attikon hospital , Greece konstantinos kagouridis
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - chonnam national university , Korea (South) Byung Hyun Baek
  • - Shinchon Severance hospital , Korea (South) Hye Mi Kim
  • - Dong-A University Hospital , Korea (South) Bo Sung Kim
  • - Sunchun university hospital, Bucheon , Korea (South) Bae So Young
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - G.R. Medical College, Gwalior , India Rajesh Pillai
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Apollo Gleneagles hosp kolkata , India SALIM PARVEZ
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - Asan Medial center , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 48/128,  37.5%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - radiologist, aditya imaging centre , India vivek patel
  • - kovai medical centre , India k bhaskar
  • - SMG-SNU boramae medical center , Korea (South) Kwang Nam Jin
  • - All India Institute of medical sciences , India Justin Moses
  • - Chonbuk National University Hospital , Korea (South) Jisoo Song
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Doctors Hospital , Bahamas muneesh sharma
  • - bmcri , India sanjeev choudri
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Bundang CHA hospital , Korea (South) Sojung Kim
  • - Chonnam National University Hwasoon Hospiral , Korea (South) You Ri Choi
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - KUMC ansan , Korea (South) kihwan kim
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Hando general hospital , Korea (South) Jee eun Lee
  • - McGill University Health Center , Canada Alexandre Semionov
  • - McGill University , Canada Ben Smith
  • - Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - Seoul National University Hospital , Korea (South) Hyungjin Kim
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Department of Diagnostic Radiology, Chonbuk National University Hospital , Korea (South) Eun Jung Choi
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sangmin Lee
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - CHRU lille , France manuel toledano
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - chonnam university hospital , Korea (South) shin hyun
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Saga University , Japan Ryoko Egashira
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - jobless , France jean-baptiste Noel
  • - CHU Notre-Dame Montreal , Canada Fabrice Bing
  • - IRSA Rochefort , France Viviane Pages
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

This website is optimized for IE 10 and above.