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Weekly Chest CasesArchive of Old Cases

Case No : 683 Date 2010-11-29

  • Courtesy of Hua Sun Kim, Hye-Jeong Lee, Ji Eun Nam, Jin Hur, Byoung Wook Choi, Kyu Ok Choe, / Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Korea.
  • Age/Sex 19 / M
  • Chief ComplaintFever, dyspnea, cough, and sputum for 1 day
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Acute eosinophilic pnuemonia
Radiologic Findings
Fig 1. Chest PA shows diffuse ground glass opacities and reticular opacities in both lungs.
Fig 2-5. Lung setting of the chest CT scan shows interlobular septal thickening with smooth margin and some centrilobular/lobular ground glass attunuations with both upper lung dominance.
Fig 6. Mediastinal setting of chest CT scan shows small amount of right pleural effusion and small right hilar lymph node. He had a history of recent onset tobacco smoking for 2 weeks. For the diagnostic work up, BAL was done. On BAL analysis, many eosinophils are seen. The patient underwent TBLB and the pathologic diagnosis was focal eosinophilic aggregates in alveolar space with interstitial infiltrates, suggestive of eosinophilic pneumonia.
Fig 7. 4 days after admission. Chest PA shows marked improvement of patchy GGOs in both lung fields.
Brief Review
Acute eosinophilic pneumonia is an acute severe febrile illness associated with rapidly increasing shortness of breath and hypoxemic respiratory failure. The diagnosis is based on clinical findings of acute respiratory failure and presence of markedly elevated numbers of eosinophils in BAL fluid. Peripheral blood eosinophile percentages are usually normal, although they become elevated during the subsequent clinical course. The majority of cases are idiopathic. Occasionally, it may result from drug reaction or inhalation exposure to smoke, particularly cigarette smoke. Tobacco smoke has been shown to be a trigger for acute eosinophilic pneumonia, especially in new-onset smokers. Patients respond rapidly to high doses of corticosteroids, usually within 24 hrs.

Typical radiographic finding is diffuse bilateral reticular opacities with or without patchy consolidation and pleural effusion. On chest CT, it shows findings of bilateral patchy area of ground glass opacity and consolidation accompanied with poorly defined nodules and smooth interlobular septal thickening. Pleural effusion is commonly combined.

The radiologic differential diagnosis for AEP includes hydrostatic pulmonary edema, adult respiratory distress syndrome or acute interstitial pneumonia, and atypical bacterial or viral pneumonia. However, developing a clinicoradiologic differential diagnosis for AEP is often difficult because initial peripheral blood eosinophil counts are usually normal.
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 : 99

▶ Correct Answer : 64/99,  64.6%
  • - kobe city general hospital , Japan rintaro hashimoto
  • - Mie-chuo hosp. , Japan Hitoshi KODERA
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - 遺„ , Korea (South) Jiye Sim
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Okayama University , Japan Akihiro Tada
  • - radiologist, aditya imaging centre , India vivek patel
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - Osaka University , Japan Osamu Honda
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - chonnam university hospital , Korea (South) shin hyun
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - SNUH , Korea (South) Eun Sun LEE
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - Kobe City Medical Center General Hospital , Japan Hitomi Nagano
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - CHRU lille , France manuel toledano
  • - Siirt Devlet Hastanesi , Turkey Armagan Sarac
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - hospital , Syria marwan alchami
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - chp st martin , France Mariotte benoit
  • - Chonbuk National University Hospital , Korea (South) Jisoo Song
  • - assam medical college , India aparimita g
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
  • - Chonnam university hospital , Korea (South) LEE HYUN
  • - Okayama university , Japan Mayu Uka
  • - ROK air force aerospacemedical center , Korea (South) Daekeon Lim
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - CNUH , Korea (South) Seoin Jeong
  • - Chonnam National University , Korea (South) se hee Jung
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Onomichi municipal hospital , Japan Junya Itakura
  • - NEPEAN HOSPITAL , Australia YOGESH THAKKAR
  • - All India Institute of medical sciences , India Justin Moses
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Okayama university , Japan Takeharu Yamamoto
  • - Kobe City Medical Center General Hospital , Japan Junko Ochi
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - jobless , France jean-baptiste Noel
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - sunder lal jain hospital , India sanjeev vachher
  • - Asan Medial center , Korea (South) Chae Lim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Assam Medical college , India samudra borah
  • - medical , India anup gupta
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Pneumology GHSR , Reunion fabrice paganin
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - IMS, BHU,VARANASI , India Sriram Patwari
  • - IRSA , France jean-luc BIGOT
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
▶ Correct Answer as Differential Diagnosis : 9/99,  9.1%
  • - University of British Columbia , Canada Amr Ajlan
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - ALHAYAH SCAN RADIOLOGY CENTER , Egypt Elsayed Mousa
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
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