대한흉부영상의학회 Weekly Chest Cases

Case No : 605 Date 2009-05-31

Courtesy of Song Choi, Hyun Ju Seon, Yun Hyeon Kim. / Chonnam National University Hospital
Age/Sex 54 / M
Chief ComplaintCough, sputum, exertional dyspnea (D: 4 months)

Figure 1
Figure 2
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Figure 4
Figure 5

Diagnosis With Brief Discussion

Diagnosis: Hot Tub Lung Disease
Radiologic Findings: Chest radiogram shows diffuse GGO with mixed fine nodular density and coarse reticular opacities in both lungs (Figure 1). Lung window setting of the chest CT scans show bilateral diffuse GGOs and discrete lobular areas of decreased attenuation in both lungs and diffuse scattered ill-defined centrilobular nodules in LLL (Figure2-4). Follow up chest radiogram after 6 days, there is no remarkable change of the lesions mentioned above (Figure 5).

Bronchoscopy was done and pathologic diagnosis was hypersensitivity pneumonitis, and NTM(M. fortuitum, M. terrae) was cultured from sputum and water obtained his place of work (fish farm). The diagnosis is hot tub lung disease.
Brief Review: "Hot tub lung" is hypersensitivity pneumonitis associated with inhaled MAC, often from hot tub exposure. Lung biopsies show features of hypersensitivity pneumonitis and cultures frequently grow MAC. Affected patients present with dyspnea, cough, and fever. Chest radiographs usually show abnormal findings, including diffuse fine nodular and reticulonodular opacities, diffuse opacities, and areas of consolidation. Characteristic CT findings are ill-defined centrilobular nodules and areas of ground-glass attenuation which typically have diffuse but patchy distribution throughout both lungs. Treatment is removal from the source of exposure (i.e., the hot tub), with antimycobacterial therapy.
References: 1. CT Findings of Granulomatous Pneumonitis Secondary to Mycobacterium avium-intracellulare Inhalation: "Hot Tub Lung" AJR 2007;188:1050-1053
2. The Many Faces of Pulmonary Nontuberculous Mycobacterial Infection. AJR 2007;189:177-186
Keywords: Lung, Interstitial lung disease, HP, NTM,

No. of Applicants : 86

▶ Correct Answer : 41/86, 47.7%

- Shiga University of Medical Science , Japan Norihisa Nitta
- CHRU lille , France manuel toledano
- Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
- EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
- eph ain beida , Algeria bourahli monia
- Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
- Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
- Clinica Las Condes , Chile David LadronDeGuevara
- CH Macon , France sebastien LARIVE
- Osaka University , Japan Osamu Honda
- Oita University, Faculty of Medicine , Japan Fumito Okada
- DCA, , India Rajesh Gothi
- Nirman hitech diagnostic centre , India minal seth
- Assam medical college , India Karunakaran M
- Gimpo Woori Hospital , Korea (South) Son Youl Lee
- Saga University , Japan Ryoko Egashira
- McGill University Health Centre , Canada Amr Ajlan
- CHU GRENOBLE FRANCE , France anne-line MORONI
- Father Muller Medical College , Mangalore , India nabil mahmood
- IRSA La Rochelle France , France Denis Chabassiere
- CHU caen , France nicolas gautier
- Samsung Medical Center , Korea (South) Hye Sun Hwang
- CH Sud Rnion , Reunion jean-baptiste Noel
- Louisiana State University - Shreveport , United States Carlos Previgliano
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- Mackay Memorial Hospital , Taiwan Sheng-Yeh Shen
- Hospital M de Deus , Brazil Thiago Bento da Silva
- Seoul National University Hospital , Korea (South) Sang Min Lee
- Seoul National University Bundang Hospital , Korea (South) Kwang Nam Jin
- CHUV, Lausanne , Switzerland Andrea Ojanguren
- Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
- Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
- Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- The Armed Forces Daegu Hospital , Korea (South) Hyungwoo Oh
- Seoul Nationial University Bundang Hospital , Korea (South) Kyoung Jin Oh
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
- PITTWATER RADIOLOGY , Australia Julie Arora
- UZ GASTHUISBERG , Belgium Johan COOLEN
- Armed Forces Chun-Cheon Hospital , Korea (South) Chae Lim

▶ Correct Answer as Differential Diagnosis : 24/86, 27.9%

- Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
- CHRU Lille , France Benjamin Damarey
- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- hospital Sao Paulo , Brazil israel missrie
- KING KHALID UNIVERSITY HOSPITAL,RIYADH , Saudi Arabia NABIL GHALEB
- Univ. of Miami/Jackson Memorial , United States mantosh rattan
- WARABI CITY HOSPITAL , Japan YASUO OKUBO
- HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- MD SKNMC & GH,Pune,Maharashtra, INDIA , India Sushant Bhadane
- Toyama University Hospital, Laboratory of Pathology , Japan TANAKA TOMONORI
- Paramount Diagnostic & Research Centre , India Mahavir Swami
- Changhua Christian Hospital , Taiwan Chia-Fu Tsai
- clinique de rochefort , France viviane pages
- chp st martin , France Mariotte benoit
- Hopital du SacrCoeur , Canada Abraham Bohadana
- Homs National Hospital , Syria Rami Abou Zalaf
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Trakya University School of Medicine , Turkey Umut Ugur
- McGill University Health Center , Canada Alexandre Semionov
- NASA SCANS , India RAKESH BHATIA
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- govt royapettah hospital , India gopinathan kathirvelu

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 605 Date 2009-05-31

Discussion

No. of Applicants : 86