대한흉부영상의학회 Weekly Chest Cases

Case No : 427 Date 2006-01-02

Courtesy of Woon-Jung Kwon, Ae Kyung Jeong / Department of Diagnostic Radiology, Ulsan University Hospital
Age/Sex 29 / F
Chief ComplaintShe complained of progressive dyspnea. She took herb medicine a few days ago.

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Diagnosis With Brief Discussion

Diagnosis: Acute Hypersensitivity Pneumonitis
Radiologic Findings: At admission, chest radiograph shows ill-defined increased opacities, in predominantly both lower lung zones. After 1day later, density and extent of lesions were more extended and endotracheal tube was inserted in trachea. HRCT images represent ill-defined ground glass opacities with interlobular septal thickenings in both lungs and ill-defined areas of consolidations in both lower lobes. The initial differential diagnoses were acute interstitial pneumonia, Pneumocystis jiroveci pneumonia, and diffuse alveolar hemorrhage. In BAL fluid, lymphocystosis (67%) was found.

A section of a transbronchial lung biopsy specimen shows a cellular infiltrate composed predominant lymphocytes, accompanied by variable numbers of epitheliod histiocytes, plasma cells, and eosinophils.

She had a history of same symptom associated with herb medication three years ago.
Brief Review: The term hypersensitivity pneumonitis (extrinsic allergic alveolitis) denotes a group of disease characterized by an abnormal immunologic reaction in the lung to specific antigens in a wide variety of organic dusts. Diagnosis must be suspected primarily on the basis of the clinical history, and meticulous inqury may be required to uncover an exposure coincident with the development of acute respiratory symptoms. Histologic appearance consists of a combination of bronchiolitis and aveolitis with granuloma formation. The radiologic findings vary with the stage of the disease. Early in the course of the acute stage, the chest radiograph may show no abnormality, even in patients who have florid pathologic changes on lung biopsy. Later on, the characteristic finding consists of bilateral areas of consolidation, which may be diffuse or involve mainly the lower lung zones.
References: Fraser, Colman, Muller, Pare Synopsis of disease of disease of the chest 3rd edition 505-511
Keywords: Lung, Non-infectious inflammation, HP, ILD,

No. of Applicants : 40

▶ Correct Answer : 9/40, 22.5%

- Jikei University School of Medicine, Tokyo, Japan Masuo Ujita
- National Taiwan University Hospital, Taiwan Yu-Feng Wei
- Doma Hospital, Damascus, Syria Mostafa Dakak
- University Hospital of Ghent Kristof De Cuyper
- MH (CTC) Pune, India Vivek Sharma
- Seoul National University Hospital, Korea Se-Yeong Chung
- CHRA, Annecy France Bing Fabrice
- St Vincent Hospital, Korea Chae Hun Lim
- Apollo FirstMed Hospital, Chennai, India Gopinath R G

▶ Correct Answer as Differential Diagnosis : 13/40, 32.5%

- Samsung Medical Center, Seoul, Korea Ha Young Kim
- Regional Imaging, Riverina, Australia Rashid Hashmi
- China Medical University Hospital, Taiwan Sea-Harn Pan
- Fleury Medical Center, Sao Paulo, Brazil Gustavo Meirelles
- Shahid Beheshti Hospital, Kashan, Iran Ebrahim Razi
- Hereford County Hospital, UK Joy A Thomas
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Chikuhou Rousai Hospital, Japan Kouei Uchida
- Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Annemasse, Polyclinique de Savoie, France Gay-Depassier
- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi

▶ Semi-Correct Answer : 13/40, 32.5%

- Marien Hospital, Hamm, Germany Davis Chiramel
- National Taiwan University Hospital, Taiwan Kao-Lang Liu
- EKH Berlin, Germany Michael Weber
- HIS Hospital, Brussels, Belgium Emmanuel Agneessens
- B.J.Medical College, University of Pune (retired), India Bankim Amin
- Marien Hospital, Hamm, Germany Davis Chiramel
- Maimonides Medical Center; Brooklyn, New York, USA Naomi Twersky
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Annecy France Brigitte Bardot
- Incheon Sarang Hospital, Korea Jung Hee Kim
- China Medical University Hospital,Taiwan Jun-Jun Yeh
- Hospital Monaldi, Naples, Italy Gaetano Rea
- Max Hospital, New Delhi, India Vickrant Malhotra

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 427 Date 2006-01-02

Discussion

No. of Applicants : 40