대한흉부영상의학회 Weekly Chest Cases

Case No : 1358 Date 2023-10-31

Courtesy of So Youn Shin / Kyung Hee University Hospital
Age/Sex 70 / F
Chief Complaintfever, rash (onset: 1 week ago), on physical exam: left axilla eschar with past history of HTN, DM, dyslipidemia, S/P PCI at LAD, non-smoker

Figure 1
Figure 2

Diagnosis With Brief Discussion

Diagnosis: Scrub typus (Tsutsugamushi disease)
Radiologic Findings: Figure 1. Chest PA shows mild pulmonary edema, small bilateral pleural effusion, and mild cardiomegaly.
Figure 2A-D. On chest and Abdominal CT, there are mild diffuse interlobular septal thickening in both lungs with scanty bilateral pleural effusion. And there are axillary lymph nodes enlargement and mild cardiomegaly, Also, hepatosplenomegaly and periportal edema in the liver are noted.
Brief Review: This patient visited the hospital (October) due to fever and rash for 1 week. The patient’s house is located in mountains and she often went to the mountain. In the hospital, doctors found left axillary eschar. On the serum antibody test, Tsutsugamushi antibody showed positive result. After medication, her imaging and clinical symptoms improved.
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The main pathologic change is focal or disseminated vasculitis caused by the destruction of endothelial cells and the perivascular infiltration of leukocytes.
The diagnosis of scrub typhus is based on the patient’s history of exposure, clinical features, and results of serologic testing. Regional and generalized lymphadenopathy is common. The pulmonary manifestations of scrub typhus include interstitial pneumonia, interstitial edema, and hemorrhage caused by vasculitis. Abdominal manifestations include splenomegaly, periportal edema, gallbladder wall thickening, and lymphadenopathy.
The imaging findings, including ground glass opacity, interlobular septal thickening, centrilobular nodules, and bronchial wall thickening could be useful in differentiating it from other acute epidemic febrile illnesses such as leptospirosis and epidemic hemorrhagic fever. Scrub typhus is an interstitial lesion in the majority of cases with hilar lymph node enlargement with rather slow resolution.
Please refer to
References: 1) Clinical Radiology 2000; 55:140-144.
2) RadioGraphics 2007; 27:161-172.
Keywords

No. of Applicants : 74

▶ Correct Answer : 59/74, 79.7%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan SUZUNE TSUKAMOTO
- , Japan HIROAKI ARAKAWA
- The University of Tokyo Hospital , Japan JUN KANZAWA
- , Japan KYOKO NAGAI
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
- Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
- Chonnam National University Hwasun Hospital , Korea (South) DONGHUN HAN
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Other , Korea (South) SEONGSU KANG
- Scans world , India PHILSON JOSEPH MUKKADA
- , Korea (South) JIN YOUNG LEE
- , China FANG YING GEN
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- , Korea (South) KANGHWI LEE
- Osaka University , Japan AKINORI HATA
- , Japan HIKARI FUKUI
- Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
- OITA UNIVERSITY , Japan FUMIKA ISHITOBI
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Presbyterian Medical Center , Korea (South) SOOYEON JEONG
- Gifu University Hospital , Japan Yo Kaneko
- Kyoto University Hospital , Japan YASUHISA KURATA
- , Japan SHUNJIRO NOGUCHI
- , Korea (South) HEONSEOK LEE
- Tokyo Medical and Dental University , Japan MIKIYA FUJII
- Chungbuk National University Hospital , Korea (South) MIHYEON PARK
- Mie university , Japan MIYUKO FUJITA
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Korea University Guro Hospital , Korea (South) LEE DAKYONG
- Mie university , Japan SHIKO OKABE
- Manipal hospital Hebbal, Bengaluru , India PRAVIN KUMAR M
- Seoul National University Hospital , Korea (South) SUNGHO HONG
- Others , India PURUSHOTHAMA RAO TUMMALA
- , China MING LU
- Chonnam National University Hospital , Korea (South) KIM SANG GYUN
- Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- Mie University Hospital , Japan KENSUKE DOMAE
- , Taiwan SHIHHAN PAN
- Paras hospital, Panchkula , India SHALEEN RANA
- Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
- CHA University, CHA Bundang Medical Center , Korea (South) HWANGSEON JU
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Fukuoka university , Japan KEISUKE SATO
- Chonnam Hospital , Korea (South) JAEHYUN PARK
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
- Matsunami General Hospital , Japan TARO TAKEDA
- , Japan YUMI MAEHARA
- Shiga University of Medical Science , Japan RYO UEMURA
- , Korea (South) JIYEONG AN
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
- Kyoto university , Japan AKIHIKO SAKATA
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- , Korea (South) JIN WOO YOON
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 3/74, 4.1%

- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- , Japan KENTARO KOTANI
- Kyoto University , Japan SHO KOYASU

▶ Semi-Correct Answer : 2/74, 2.7%

- The University of Tokyo Hospital , Japan WATARU GONOI
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1358 Date 2023-10-31

Discussion

No. of Applicants : 74