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Weekly Chest CasesArchive of Old Cases

Case No : 901 Date 2015-02-02

  • Courtesy of Yoon Kyung Kim, Yon Mi Sung, Eun Young Kim / Gachon University Gil Medical Center
  • Age/Sex 56 / F
  • Chief Complaintcough, exertional dyspnea, myalgia, arthralgia
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Organizing pneumonia associated with polymyositis
Radiologic Findings
Initial HRCT show peribrochovascular and subpleural consolidation in both lungs (both mid to lower lung zone predominance), which are suggestive of interstitial lung disease such as cryptogenic organizing pneumonia. Left thigh MRI including enhancement shows multifocal patchy T2-high signal intensity lesions with variable enhancement in rectus femoris, vastus lateralis and intermedius muscles. These findings are suggestive of inflammatory myopathy.
Transbronchial lung biopsy revealed pneumonia pattern and possibility of bronchiolitis obliterans with organizing pneumonia. Muscle biopsy from left thigh was consistent with inflammatory myopathy. On laboratory finding, muscle enzyme and anti Jo-1 antibody level were elevated.
After 1-month-treatment with steroid and immunosuppressive agents, dyspnea and muscle enzyme elevation were improved. Follow up chest radiograph and CT showed decreased extent of consolidation in both lungs.
Brief Review
Pulmonary complications occur in more than 40% of patients. Common complications include ILD, aspiration, pneumonia, and drug-induced lung diseases. It is estimated that 35-40% of patients with PM-DM develop ILD during the course of their disease. The pattern of involvement is most commonly NSIP. Other histologic patterns are OP, UIP and DAD. HRCT findings of PM-DM include ground-glass opacity, findings of fibrosis (honeycombing is uncommon), and consolidation. In more than 90% of patients, the findings involved mainly the lower lobes.
References
High resolution CT of the lung, 5th edition, 268-270.
Keywords
Lung, Connective tissue diseases, Polymyositis,

No. of Applicants : 79

▶ Correct Answer : 7/79,  8.9%
  • - CHRU Lille , France Julien Pagniez
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Private SECTOR - ITALY , Italy CARLO FLORIO
  • - All India Institute of medical sciences , India Justin Moses
▶ Correct Answer as Differential Diagnosis : 2/79,  2.5%
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
▶ Semi-Correct Answer : 55/79,  69.6%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Kyoto University , Japan Akihiko Sakata
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Pamukkale University, School of Medicine, Dept. of Radiology , Turkey Nevzat Karabulut
  • - Haeundae Paik Hospital , Korea (South)
  • - University of British Columbia , Canada Amr Ajlan
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - SNUH , Korea (South) Eui Jin Hwang
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - alzahra , Iran johary s
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Hopital Bichat , France, Metropolitan Pauline Pradere
  • - Niigata University , Japan Atsushi Uehara
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Isfahan university of medical science , Iran Elham Ghorbani
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - GHICL , France manuel toledano
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Seoul National University Hospital , Korea (South) Jaeseok Bae
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - McGill University Health Center , Canada Alexandre Semionov
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - CNUH , Korea (South) Noh Hoon
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Severance hospital , Korea (South) SeungHyun Park
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - CHRU Lille , France Paul Lebert
  • - Diagnose.me (BV) , Australia Yuranga Weerakkody
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - NASA SCANS , India RAKESH BHATIA
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Chonnam national university hospital , Korea (South) INSOO JANG
  • - Ibaraki-gazou-shindan , Japan Shoichi Katoh
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Fukuyama City Hospital , Japan Mayu Uka
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