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Weekly Chest CasesArchive of Old Cases

Case No : 774 Date 2012-08-27

  • Courtesy of Jung Won Kwak, Ji Yung Choo, Ki Yeol Lee / Korea University Ansan Hospital
  • Age/Sex 60 / F
  • Chief ComplaintRLQ pain (2 months ago) Clinical history of sialoadenitis (present), thyrotoxicosis (3yrs ago), chronic sinusitis (8yrs ago)
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Figure 1

Diagnosis With Brief Discussion

Diagnosis
IgG4 related lung disease
Radiologic Findings
Chest CT shows two well-enhancing nodular lesions in RLL superior and posterobasal segment. Pleura-based nodule is also seen in RUL. There is mesenteric fat infiltration on abdomen CT.
The patient underwent VATS resection and laparoscopic mesenteric resection for diagnosis.
The pathologic report revealed numerous IgG4-positive plasma cells and it was confirmed as IgG4 related lung disease.
Brief Review
Recently, increasing attention has been drawn to IgG4 related disease. IgG4 related lung disease is a spectrum of systemic IgG4 related disease characterized by extensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs.
The radiologic features of IgG4 related lung disease could be classified into four types : solid nodular, round-shaped GGO, alveolar interstitial, and bronchovascular. Differential diagnosis varies among radiologic features: lung cancer (solid nodular type), adenocarcinoma (round-shaped GGO), interstitial pneumonia (alveolar interstitial), sarcoidosis or lymphoplroliferative disease (bronchovascular).
Complete surgical resection is recommended for both diagnosis and treatment. However, some reports that IgG4 related lung disease response to corticosteroid therapy.
References
1. Dai Inoue, Yoh Zen, Hitoshi Abo, Toshifumi Gabata, Hiroshi Demachi, Takeshi Kobayashi, Jyuun Yoshikawa, Shiro Miyayama, Masahide Yasui, Yasuni Nakanuma, Osamu Matsui : Immunoglobulin G4-related Lung Disease : CT findings with Pathologic Correlations. Radiology 2009; 251:260-270.
2. Paraskevi A. Vlachou, Korosh Khalili, Hyun-jung Jang, Sandra Fischer, Gideon M. Hirschfield, Tae Kyound Kim : IgG4-related Sclerosing Disease : Autoimmune Pancreatitis and Extrapancreatic Manifestations. Radiographics 2011; 31:1379-1402.
Keywords
lung, metabolic ans storage, systemic disease,

No. of Applicants : 67

▶ Correct Answer : 21/67,  31.3%
  • - Kurashiki Seijin-byo Center , Japan Akihiro Tada
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Teikyo mizonokuchi hospital , Japan Takana Yamakawa
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Samsung Medical Center , Korea (South) Chae Jin Jeong
  • - ASAN MEDICAL CENTER , Korea (South) CHONG HYUN SUH
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - CHRU lille , France manuel toledano
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - All India Institute of medical sciences , India Justin Moses
  • - CAC Rennes , France nicolas gautier
  • - Shree Diagnostics , India amol jagdale
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - H�pital du Sacr , Canada Andrea Ojanguren
  • - Okayama university , Japan Mayu Uka
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 10/67,  14.9%
  • - UWO , Canada S Lee
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - XiangYa hospital , China Xia Yu
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
▶ Semi-Correct Answer : 3/67,  4.5%
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Goa Medical College , India Paresh Desai
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
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