대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 59 Date 1998-12-14

  • Courtesy of Tae Sung Kim, M.D., Kyung Soo Lee, M.D. / Samsung Medical Center
  • Age/Sex 45 / F
  • Chief Complaintdyspnea
  • Figure 1
  • Figure 2

CPA

Diagnosis With Brief Discussion

Diagnosis
Hypersensitivity pneumonitis (Extrinsic allergic alveolitis)
Radiologic Findings
(a) Chest radiograph shows diffuse reticulonodular opacities are scattered in the lung.
(b) Lung window of thin-section (1.0-mm collimation) CT scan obtained at level of aortic arch shows poorly-defined micronodules in both lungs with centrilobular distribution. Also note background area of ground-glass opacity.

(c) Photomicrograph of surgical specimen (H & E, x 40) reveals scattered nonnecrotizing poorly-formed granulomas (arrows) in periarteriolar and peribronchiolar interstitium. Also note chronic inflammatory cell infiltration in membranous bronchiole with luminal dilatation (arrowhead).

Allergic lung disease resulted from inhalation of antigenic organic dusts.
Farmer’s lung: representative of hypersensitivity pneumonitis, induced from inhalation of fungal organism.
Three stages:
1. Acute stage: diffuse poorly-defined air-space consolidation / ground-glass attenuation.
Pathologically, alveolar filling of polymorphonuclear cells, eosinophils, and lymphocytes.
2. Subacute stage: fine nodular pattern showing peribronchial distribution.
3. Chronic stage: patchy fibrosis.

DDx.
1. Desquamative interstitial pneumonia: No nodules.
2. Pulmonary alveolar proteinosis: smooth interlobular septal thickening within the area of ground-glass attenuation
(so called, crazy-paving appearance).
Brief Review
References
Keywords
Lung, Inhalation and aspiration disease, HP, Hypersensitivity pneumonitis (Extrinsic allergic alveolitis)

No. of Applicants : 23

▶ Correct Answer : 18/23,  78.3%
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▶ Semi-Correct Answer : 3/23,  13.0%
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