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Weekly Chest CasesArchive of Old Cases

Case No : 595 Date 2009-03-23

  • Courtesy of Yoon Kyung Kim, MD, Ok Hee Woo, MD, Hwan-Seok Yong, MD, Eun-Young Kang, MD. / Korea University Guro Hospital, Korea
  • Age/Sex 24 / F
  • Chief ComplaintDyspnea, cough, Asthma for 1 year
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Churg-Strauss syndrome
Radiologic Findings
Posteroanterior chest radiograph shows multifocal patchy consolidations in both lungs. Thin-section CT scans show multifocal, patchy, peribrochovascular or subpleural ground-glass opacities and consolidations. She had paranasal sinusitis and peripheral blood eosinophilia (60%). Histopathologic findings from skin and lung were consistent with Churg-Strauss syndrome.
Brief Review
CSS is histopathologically characterized by eosinophil tissue infiltration, necrotizing vasculitis, and extravascular granulomas. The American College of Rheumatology (ACR) classification of CSS includes six criteria, i.e., asthma, eosinophilia of >10% white blood cell count, migratory or transient pulmonary opacities on chest radiographs, mononeuropathy or polyneuropathy, paranasal sinus abnormalities, and extravascular eosinophils on biopsy. According to this classification, the presence of four or more of these six criteria allows a diagnosis of. Clinically, CSS is known to respond dramatically to corticosteroid therapy.
Although radiologic findings are nonspecific, the most common radiographic findings reported are transient, patchy, and nonsegmental consolidation or small and large nodular opacities. About three-quarters of patients with CSS show parenchymal lung lesions at CT. These consist predominantly of small centrilobular nodules and tree-in-bud sign, GGO, consolidation, bronchial dilatation or wall thickening, interlobular septal thickening, and mosaic perfusion pattern.
References
1. Kim YK, Lee KS, Chung MP et al. Pulmonary involvement in Churg-Strauss syndrome: an analysis of CT, clinical, and pathologic findings. Eur Radiol 2007; 17: 3157-165
Please refer to
Case 262 Case 523
Keywords
Eosinophilic lung disease, Churg-Strauss, Vasculitis,

No. of Applicants : 97

▶ Correct Answer : 22/97,  22.7%
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - hospital Sao Paulo , Brazil israel missrie
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Saboo Hospital , India Sandeep Saboo
  • - CHRU Lille , France Benjamin Damarey
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - govt royapettah hospital , India gopinathan kathirvelu
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Soon chun hyang university hospital BUCHEON , Korea (South) Yang yeon
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - kyungpook national university hospital , Korea (South) jiwon park
  • - Kyungpook National Univ. Hospital , Korea (South) Sang-yub Lee
  • - Medical IT Consulting , Japan Kazumasa Nishimura
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - CHU caen , France nicolas gautier
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Correct Answer as Differential Diagnosis : 13/97,  13.4%
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - kims,narkatpally , India k bhaskar
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - CHU Grenoble , France Fabrice Bing
  • - SNUBH , Korea (South) Kyoung Jin Oh
  • - Kangnam Sacred Heart Hospital , Korea (South) Jaewon Kim
  • - IRSA , France jean -luc BIGOT
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
▶ Semi-Correct Answer : 1/97,  1.0%
  • - CH Sud Rnion , Reunion jean-baptiste Noel
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