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Weekly Chest CasesImaging Conference Cases

Case No : 3

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  • Age/Sex 16 / F
  • Case Title Spiking fever for 5 days & dry cough for one day, SLE (diagnosed, one year ago)
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  • Figure 5

Diagnosis With Brief Discussion

Courtesy
Youido St. Mary's Hospital, TheCatholic University
Discussion
Diagnostic Workup
Bronchoscopy

No abnormal finding except a few mucosal erythematous lesion

BAL : Increasingly bloody fluid in successive regurged lavage

AFB stain(-) Silver stain(-), Bacterial culture(-) Fungal culture(-)
Viral culture (-) : influenza A/B, parainfluenza, RSV, Adenovirus, CMV

TBLB

Acute pulmonary Involvement of the SLE
Infectious pneumonia
Acute lupus pneumonitis
Patchy consolidation , often found at the lung bases with pleural effusion
Pulmonary alveolar hemorrhage
Uniform, ill-defined, centrilobular nodules without zonal predominancy

Ground-glass attenuation and airspace consolidation

Rapid development and improvement

Abnormal thickening of the interlobular septa as interstitial fibrosis





Pulmonary aoveolar hemorrhage in SLE
Clinical Presentation

Dyspnea, Fever, Cough, Hemoptysis(54%)

Decrease of Hb(>1d/dl)

Newly developed pulmonary infiltrate



Potentially catastrophic complication (mortality ratio exceeds 50% or more)

Rarely seen as initial manifestation

Commonly associated with lupus nephritis : pulmonary-renal syndrome

Diagnosis
Elevated diffusing capacity of the lung for CO(>30%)

Bronchoscopy with BAL

Aspiration of the successive aliquots yields increasingly bloody BAL fluid

Hemosiderin-laden macrophage
Reference
Diagnostic Workup
Bronchoscopy

No abnormal finding except a few mucosal erythematous lesion

BAL : Increasingly bloody fluid in successive regurged lavage

AFB stain(-) Silver stain(-), Bacterial culture(-) Fungal culture(-)
Viral culture (-) : influenza A/B, parainfluenza, RSV, Adenovirus, CMV

TBLB

Acute pulmonary Involvement of the SLE
Infectious pneumonia
Acute lupus pneumonitis
Patchy consolidation , often found at the lung bases with pleural effusion
Pulmonary alveolar hemorrhage
Uniform, ill-defined, centrilobular nodules without zonal predominancy

Ground-glass attenuation and airspace consolidation

Rapid development and improvement

Abnormal thickening of the interlobular septa as interstitial fibrosis





Pulmonary aoveolar hemorrhage in SLE
Clinical Presentation

Dyspnea, Fever, Cough, Hemoptysis(54%)

Decrease of Hb(>1d/dl)

Newly developed pulmonary infiltrate



Potentially catastrophic complication (mortality ratio exceeds 50% or more)

Rarely seen as initial manifestation

Commonly associated with lupus nephritis : pulmonary-renal syndrome

Diagnosis
Elevated diffusing capacity of the lung for CO(>30%)

Bronchoscopy with BAL

Aspiration of the successive aliquots yields increasingly bloody BAL fluid

Hemosiderin-laden macrophage
Keywords
Lung, Connective tissue diseases, SLE, Pulmonary alveolar hemorrhage in SLE
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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