대한흉부영상의학회 Weekly Chest Cases

Case No : 262 Date 2002-11-02

Courtesy of Jin Mo Goo, M.D., Jung-Gi Im, M.D. / Seoul National University Hospital, Seoul, Korea
Age/Sex 41 / F
Chief ComplaintAsthma, skin lesions, both hands and lower extremity weakness, blood eosinophilia (15%).

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Diagnosis With Brief Discussion

Diagnosis: Churg-Strauss Syndrome (Allergic Angiitis and Granulomatosis)
Radiologic Findings: Posteroanterior chest radiograph shows multifocal patchy nonsegmental consolidations in both lungs. Thin-section CT scans show multifocal patchy consolidations and poorly defined nodules in subpleural region.
She had paranasal sinusitis. Histopathologic findings from skin, nerve, and soft palate biopsies were consistent with Churg-Strauss syndrome (necrotizing vasculitis with or without eosinophil infiltration).
Brief Review: Churg-Strauss syndrome (allergic angiitis and granulomatosis) is characterized by hypereosinophilia, asthma, and systemic vasculitis. This disease, which usually occurs in middle age, is a multisystem disorder with predilection for the lungs, skin, nervous system, gastrointestinal tract, heart, kidney and joints.
Clinically, there are three distinct phases: (1) a prodromal phase that may persist for many years, consisting of asthma, often preceded by allergic rhinitis; (2) a second phase of marked peripheral blood eosinophilia and eosinophilic tissue infiltrates resembling Loffler’s syndrome, or chronic eosinophilic pneumonia, which may recur over a period of years; and (3) a third, life-threatening vasculitic phase.
Chest radiographs show bilateral nonsegmental consolidation, reticulonodular opacities, bronchial wall thickening, and multiple nodules. The most common thin-section CT findings include bilateral ground-glass opacity; airspace consolidation, predominantly subpleural and surrounded by the ground-glass opacity; centrilobular nodules mostly within the ground-glass opacity; bronchial wall thickening; and increased vessel caliber. In contrast to Wegener’s granulomatosis, cavitation of nodules is rare.
References: 1. Choi YH, Im JG, Han BK, Kim JH, Lee KY, Myoung NH. Thoracic manifestation of Churg-Strauss syndrome: radiologic and clinical findings. Chest. 2000;117:117-124.
2. Seo JB, Im JG, Chung JW, Song JW, Goo JM, Park JH, Yeon KM. Pulmonary vasculitis: the spectrum of radiological findings. Br J Radiol 2000;73:1224-1231.
3. Lanham, JG, Elkon, KB, Pusey, CD, et al. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine 1984;63:65-81.
Keywords: Lung, Vascular, Vasculitis, Eosinophilic lung disease,

No. of Applicants : 25

▶ Correct Answer : 18/25, 72.0%

- Annecy Hospital, France Genin Gilles
- Asan Hong-chun Hospital, Korea Sang Cheol Sihn
- CHU Grenoble, France Mathieu Rodiere
- CHU Nancy-Brabois, France Denis Regent
- Daegu Fatima Hospital, Korea Hyun Woong Shin
- Ewha Womans' University, Mokdong Hospital, Korea Yookyung Kim
- Gospel Hospital Kosin University, Korea Kyung Hwa Jung
- Gwangmoung Seongae Hospital, Korea Jiyong Rhee
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Harasanshin hospital, Fukuoka, Japan Shunya Sunami
- Hospital of Leon, Spain Inmaculada Herraez
- IMSL, metz, France Eric Gaconnet
- Korea University Anam Hospital, Korea Bokyung Je
- Korea university Guro hospital, Korea Ok Hee Woo
- P.D. Hinduja Hospital, Munbai, India Sharad Bidari
- Sanghari subhealth center, Yecheongun, Korea Hyung-Keun Kim
- Sarang Hospital, Incheon, Korea Jung Hee Kim
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate

▶ Semi-Correct Answer : 3/25, 12.0%

- Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
- Ospedale di Jesi, Italy Giancarlo Passarini
- Samsung Medical Center, Korea Hyowon Eun

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 262 Date 2002-11-02

Discussion

No. of Applicants : 25