대한흉부영상의학회 Weekly Chest Cases

Case No : 343 Date 2004-05-22

Courtesy of Choong-Ki Park, M.D. / Hanyang University Kuri Hospital, Kyoungki-Do, Korea
Age/Sex 16 / M
Chief ComplaintChest dyscomfort and dyspnea

Figure 1
Figure 2

Diagnosis With Brief Discussion

Diagnosis: Rheumatic fever
Radiologic Findings: Initial chest radiograph (Fig.1) shows triangular heart configuration with prominence of the left atrial appendage and double contoured right cardiac border. Pulmonary congestion, perihilar blurring and Kerley B lines are also seen. After 7 weeks of penicillin treatment, follow-up chest radiograph shows marked improvement of pulmonary congestion, disappeared Kerley B lines. This patient has 1 major (carditis) and 2 minor (migratory arthralgia and increased ASO (774 IU/ml) and CRP-S (5.8 mg/dl) titers.
Brief Review: Rheumatic fever is an inflammatory disease, occurs as a delayed sequel to pharyngeal infection with group A streptococci. It involves principally the heart, joints, central nervous system, skin, and subcutaneous tissue. The usual manifestations in the acute form are migratory polyarthritis, fever, and carditis. Sydenham’s chorea, subcutaneous nodules, and erythema marginatum may occur as other typical manifestations.

The mechanism by which the group A streptococcus initiates the disease process remains unknown.

The major clinical manifestations by which rheumatic fever can be recognized are polyarthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules. Minor criteria includes fever, arthralgia, abdominal pain, tachycardia, epistaxis and increased ESR or CRP.
According to Jones Criteria, two major criteria or one major and two minor criteria indicate a high probability of the presence of rheumatic fever with supporting evidence of preceding streptococcal infection: history of recent scarlet fever; positive throat culture for group A streptococcus; increased ASO titer or other streptococcal antibodies.

The course of rheumatic fever varies greatly, but in general, about 75% of acute rheumatic attacks subside within 6 weeks.

Benzathine penicillin 120IU IM is the drug of choice to eliminate group A streptococci. And good supportive therapy can reduce the mortality and morbidity of the disease
References: Principles of Internal Medicine: Rheumatic fever. 12th ed. 1991
Keywords: Mediastinum, Non-infectious inflammation,

No. of Applicants : 26

▶ Correct Answer : 7/26, 26.9%

- CHU Nancy-Brabois, France Denis Regent
- CIM Saint Dizier, France JC Leclerc
- Eulji hospital, Korea Jeong Joo Woo
- Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- National Taiwan University Hospital, Taiwan Tan Che Kim
- Social Security Hospital, Ankara, Turkey Meric Tuzun

▶ Semi-Correct Answer : 15/26, 57.7%

- Annecy Hospital, France Gilles Genin
- CH Lyon sud, France Xavier Riviere
- Dong-A University Hospital, Korea Ki-Nam Lee
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Jankharia's Imaging Centre Bhavin Jankharia
- Kocaeli medical school, Turkey Salih Topcu
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- National Taiwan University Hospital, Taiwan Sheng-Hsiang Lin
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
- Samsung Medical Center, Korea Semin Chong
- Samsung Medical Center, Korea Sung Shine Shim
- Surgico-medical Hospital, Homs, Syria A. Kalsoum
- Tulkarem, Palestine Imad Sader

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 343 Date 2004-05-22

Discussion

No. of Applicants : 26