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Weekly Chest CasesCases by Disease Category

Case No : 1374 Date 2024-02-20

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  • Courtesy of Taein An / Samsung Medical Center
  • Age/Sex 49 / M
  • Chief Complaintneuralgia, sensory loss, blood tinged sputum Brief history: asthma, op. history of paranasal sinus with nasal polyp.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
EGPA (eosinophilic granulomatosis with polyangiitis, Churg-strauss syndrome)
Radiologic Findings
Fig.1. Chest PA.
Bilateral patchy consolidations.
Fig 2. Chest CT.
Patchy consolidations and GGOs in bilateral lungs.
Mild bronchial wall thickening in the right lower lobe.
Small to borderline-sized reactive LNs in bilateral mediastina and hilar.
Small amount of pleural effusion.
Fig 3. Paranasal sinus series.
Air-fluid level in Rt. Maxillary sinus, R/O acute sinusitis.

Peripheral eosinophilia was found on laboratory test.
Brief Review
Formerly known as Churg-Strauss syndrome, it is characterized by asthma, eosinophilia, and necrotizing vasculitis. Asthma is present in almost all patients and peripheral neuritis is seen in about 75% of patients. Symptoms and signs vary over time, with the first 8 to 10 years of life characterized by atopy, sinusitis, and asthma, followed by an increase in eosinophils in the peripheral blood and gradual deposition of eosinophils in the lungs and other organs, followed by vasculitis and systemic symptoms such as fever and weight loss.
The lungs are the most commonly involved organ, and pulmonary hemorrhage or glomerulonephritis are much rarer when compared to GPA and MPA. The heart can be involved, with coronary arteritis and myocarditis being the main causes of death. Approximately 40-75% of patients with EGPA have ANCA, most often p-ANCA.
The most common plain radiography imaging findings of EGPA are transient, patchy, non-segmental, bilateral pulmonary involvement with no specific areas of consolidation. On CT, small nodules, ground-glass opacities, bronchial thickening or dilation, pulmonary consolidation, interlobular septal thickening, and mosaic perfusion are common findings.
References
J Korean Soc Radiol 2021;82(4):791-807
AJR 1998;1 70:297-300
Respiratory Medicine Case Reports 21 (2017) 1-6
Keywords

No. of Applicants : 84

▶ Correct Answer : 72/84,  85.7%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Radiance clinic , India ASHISH GOVARDHAN SARODE
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Turkey BARAN GUNDOGUS
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - , Italy PAOLO BALDASSARI
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , China FANG YING GEN
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Beaulieu clinic Geneva , Switzerland GILLES GENIN
  • - , Korea (South) KANGHWI LEE
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Osaka University , Japan AKINORI HATA
  • - Mie University , Japan HIKARI FUKUI
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - , Japan YUKIKO USUI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Seoul National University Bundang Hospital , Korea (South) JOONHYUK LEE
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Nankai medical center , Japan NORITAKA KAMEI
  • - , Japan KENTARO KOTANI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) YEONJAI KIM
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Other , Korea (South) CHAEHUN LIM
  • - Other , Korea (South) MARI A
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - Tokyo Medical and Dental University , Japan MIKIYA FUJII
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Mie university , Japan MIYUKO FUJITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Korea University Guro Hospital , Korea (South) LEE DAKYONG
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Mie university , Japan SHIKO OKABE
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Manipal hospital Hebbal, Bengaluru , India PRAVIN KUMAR M
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Kyoto University , Japan SHO KOYASU
  • - Samsung Medical Center , Korea (South) YONGJAE KWON
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Japan YUMI MAEHARA
  • - Madras medical college, Chennai. , India VINOTH KUMAR
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , Korea (South) JIN WOO YOON
  • - , China LI GUO
  • - Juntendo University , Japan YUTAKA IKENOUCHI
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 2/84,  2.4%
  • - Kyoto university , Japan HIROKAZU SAWAMURA
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
▶ Semi-Correct Answer : 5/84,  6.0%
  • - The University of Tokyo Hospital , Japan WATARU GONOI
  • - Nagoya University , Japan YASUSHI AOYAGI
  • - PVT , India KRSNA K VENO RAO
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
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