대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 635 Date 2009-12-28

  • Courtesy of Sang Hyun Paik, Jai Soung Park / Soonchunhyang University Bucheon Hospital, Korea
  • Age/Sex 65 / M
  • Chief ComplaintOccupation: Farmer, Fever, dyspnea for 5 days
  • Figure 1
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Initial chest PA

Diagnosis With Brief Discussion

Diagnosis
Scrub Typhus (Tsutsugamushi disease)
Radiologic Findings
Initial chest radiograph shows increased interstitial opacities and reticular opacities in both lungs. Followed chest radiograph shows increased the extent of hazy consolidation in both lungs and a rapid improvement
High resolution CT scan shows interlobular septal thickening, bronchovascular bundle thickening, and multifocal ground-glass opacities which are patterns of the interstitial pneumonia. On CT there are also small amount of bilateral pleural effusion.
Brief Review
The patient had an eschar on her left calf on the physical examination. Her laboratory data showed positive Rickettsia antibody, mild LFT abnormality and hyponatremia. Scrub typhus (tsutsugamushi disease) is an acute febrile illness caused by Orientia tsutsugamushi. It is transmitted to humans by the bite of mites or chiggers. Scrub typhus has epidemics in the late fall that affect a wide area of South-East Asia and the Pacific rim including the Korean Peninsula. Scrub typhus involves multiple organs including the lung, heart and central nervous system and is characterized by focal vasculitis or perivasculitis seceondary to direct endothelial injury. The diagnosis of scrub typhus is based on history of exposure, clinical features and serological testing. The main clinical manifestations are high fever, chill, headache, skin rash, myalgia, lymph node enlargement and characteristic eschar formation. The latent period of the disease is 6 to 18 days. The clinical course is usually mild and self-limited with spontaneous recovery after a few days, but some patients have a more severe course which may be fatal. The radiological findings of scrub typhus are variable, ranging from normal to fulminant pulmonary edema. On chest radiography, parenchymal abnormalities with lower lung predilection including bilateral reticulonodular opacities, groun-glass opacities, consolidation, septal lines and hilar lymph node enlargement, cardiomegaly and pleural effusions. On thin-section CT, ground-glass opacity with a gravitational distribution, bronchial wall thickening, intralobular septal thickening and centrilobular nodules which may reflect the interstitial pneumonia. The differential diagnosis of scrub typhus is pulmonary interstitial edema and pulmonary interstitial pneumonia such as viral pneumonia, Mycoplasma pneumonia, and Pneumocystis Jiroveci pneumonia etc.
References
YH Choi, SJ Kim, JY Lee, HJ Pai, KY Lee, YS Lee. Scrub Typhus: Radiological and Clinical Findings. Clinical Radiology 2000; 55: 140-44.
Keywords
Lung, Infection,

No. of Applicants : 109

▶ Correct Answer : 6/109,  5.5%
  • - SMC , Korea (South) Jihoon Cha
  • - kyungpook national university hospital , Korea (South) jiwon park
  • - Seoul National University Hospital , Korea (South) JUNG KIM
  • - ROK air force aerospacemedical center , Korea (South) Daekeon Lim
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Lee
▶ Correct Answer as Differential Diagnosis : 26/109,  23.9%
  • - Samsung Medical Center , Korea (South) Sang Yu Nam
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - partner, aditya imaging centre , India vivek patel
  • - Osaka University , Japan Osamu Honda
  • - hospital Sao Paulo , Brazil israel missrie
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - vinayaka missions medical college , India k bhaskar
  • - CHRU lille , France manuel toledano
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - spmc bikaner , India mahesh kumar
  • - Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - Department of Radiology, University of Alabama at Birmingham , United States Yukihiro Nagatani
  • - ministry of health and population , Egypt hanan tolba
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - EKH-Berlin , Germany Michael Weber
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Dongguk University International Hospital , Korea (South) Ah-young Kim
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Dong-A university hospital , Korea (South) Sang-yun LEE
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