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Weekly Chest CasesArchive of Old Cases

Case No : 782 Date 2012-10-22

  • Courtesy of Jeung Sook Kim / Dongguk University Ilsan Hospital, Gyeonggi-do, Korea
  • Age/Sex 21 / M
  • Chief Complaintdyspnea, fever, 2 days ago
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Acute eosinophilic pneumonia
Radiologic Findings
He had a history of recent work in heavy smoking environment for 3 weeks. For the diagnostic work up, BAL was done. On BAL analysis, the count of eosinophils was 42%.
Chest PA shows diffuse bilateral ill-defined opacities.
Lung setting of the chest CT images show ill-defined ground-glass opacities and consolidation in peribronchial and peripheral portion of both lungs, and smooth interlobular septal and peribronchial interstitial thickening in both lungs.
Mediastinal setting of chest CT image shows small amount of bilateral pleural effusion.
Brief Review
Acute eosinophilic pneumonia (AEP) represents a clinical entity that is distinct from other idiopathic eosinophilic lung diseases. Diagnostic criteria include acute severe 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. 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);462-467.
2. Jeong YJ, Kim KI, Seo IJ, et al. Eosinophilic lung diseases: a clinical, radiologic and pathologic overview. Radiographics. 2007:27(3);617-637.
Keywords
lung, eosinophilic,

No. of Applicants : 95

▶ Correct Answer : 51/95,  53.7%
  • - All India Institute of medical sciences , India Justin Moses
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Saga University , Japan Ryoko Egashira
  • - MITOYO GENERAL HOSPITAL , Japan Mototsugu Saeki
  • - UWO , Canada S Lee
  • - SCGH , Australia Yuranga Weerakkody
  • - Scans world , India Philson Mukkada
  • - radiologist, aditya imaging centre , India vivek patel
  • - SNUH , Korea (South) Euijin Hwang
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Kyung Hee University Medical center , Korea (North) Myung You
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - XiangYa hospital , China Xia Yu
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Chonnam national univ. hospital , Korea (South) Choi Seul-Gi
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Asan Medical Center , Korea (South) Eunyoung Kim
  • - Saint Malo , France jean-baptiste Noel
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
  • - Goa Medical College , India Paresh Desai
  • - Dong-A university hospital , Korea (South) Woo-jeong Kim
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Asan medical center , Korea (South) Cherry Kim
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - CBNUH , Korea (South) jihyung lee
  • - Korea University Guro Hospital , Korea (South) Kyungwon Doo
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Babaeski State Hospital , Turkey Umut Ugur
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Medicheck health care , Korea (South) Chae Lim
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - fmmc , India subas kandimalla
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Korea university , Korea (South) Kun Woo Kang
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Okayama university , Japan Mayu Uka
▶ Correct Answer as Differential Diagnosis : 9/95,  9.5%
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Chungbuk univertisy hospital , Korea (South) Soohyun Lee
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
▶ Semi-Correct Answer : 16/95,  16.8%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - University of British Columbia , Canada Amr Ajlan
  • - Hangang Sacred Heart Hospital , Korea (South) Younghwan Ko
  • - KING SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - chp st martin , France Mariotte benoit
  • - University of Pennsylvania , United States Lisa Jones
  • - Hanam sungshim hospital , Korea (South) CHANG IL KIM
  • - McGill university , Canada Badriya Al-qassabi
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - NATIONAL GUARD HEALTH SERVICES , Saudi Arabia MOHAMED AHAMED
  • - CHU Poitiers , France CHAN paul
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - royal melbourne hospital , Australia kimchi kings
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Alswaida- zaid alsherity hospital , Syria jehad alakabani
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
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