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Weekly Chest CasesArchive of Old Cases

Case No : 629 Date 2009-11-16

  • Courtesy of Se Kyung Park, Yeon Joo Jeong / Department of Radiology, Pusan National University Hospital
  • Age/Sex 18 / M
  • Chief ComplaintFever with dry cough for 5 days
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Acute eosinophilic pneumonia
Radiologic Findings
Chest radiograph shows ground glass and reticular opacities with peripheral consolidation in both lungs (Fig. 1). Serial thin-section CT scans show smooth peribronchial interstitial and interlobular septal thickening in both lungs and ground glass attenuation and consolidation in peripheral portion of both lungs (Figs. 2 and 3). Bilateral pleural effusions are also seen (Fig. 4). He had a history of recent onset of tobacco smoking. For the diagnostic work up, BAL was done. On BAL analysis, the count of eosinophils was more than 68%. Follow up chest radiograph on the 6 days of admission reveals marked improvement of patchy GGOs in both lung fields.
Brief Review
Acute eosinophilic pneumonia is an acute severe febrile illness associated with rapidly increasing shortness of breath and hypoxemic respiratory failure. The diagnosis is based on clinical findings of acute respiratory failure and presence of markedly elevated numbers of eosinophils in BAL fluid. The majority of cases are idiopathic. Occasionally, it may result from drug reaction (sertraline, progesterone) or inhalation exposure to smoke, particularly cigarette smoke. Tobacco smoke has been shown to be a trigger for acute eosinophilic pneumonia, especially in new-onset smokers. Patients respond rapidly to treatment with corticosteroid.

Typical radiographic finding is diffuse bilateral reticular opacities with or without patchy consolidation and pleural effusion. On chest CT, it shows findings of bilateral patchy area of ground glass opacity and consolidation accompanied with poorly defined nodules and smooth interlobular septal thickening. Pleural effusion is commonly combined.

The radiologic differential diagnosis for AEP includes hydrostatic pulmonary edema, adult respiratory distress syndrome or acute interstitial pneumonia, and atypical bacterial or viral pneumonia. However, developing a clinicoradiologic differential diagnosis for AEP is often difficult because initial peripheral blood eosinophil counts are usually normal.
References
1. Daimon T et al. Eur J Radiol 2008; 65:462-467
2. Jeong YJ et al. Radiographics. 2007:27(3), 617-37
Keywords
lung, Eosinophilic lung disease,

No. of Applicants : 103

▶ Correct Answer : 53/103,  51.5%
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - CHUV , Switzerland ANNE-SOPHIE KNOEPFLI
  • - Osaka University , Japan Osamu Honda
  • - partner, aditya imaging centre , India vivek patel
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Saga University , Japan Ryoko Egashira
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - Department of Radiology, University of Alabama at Birmingham , United States Yukihiro Nagatani
  • - CHU Montr�al , Canada nicolas gautier
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Samsung Medical Center , Korea (South) Sang Yu Nam
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Samsung Medical Center , Korea (South) Ju Won Lee
  • - University of British Columbia , Canada Amr Ajlan
  • - EKH-Berlin , Germany Michael Weber
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - CHRU lille , France manuel toledano
  • - Montreal Chest Institute , Canada Faiz Kham
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - CH Sud R�union , Reunion jean-baptiste Noel
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - KKUH , Saudi Arabia raees ahmed
  • - SMG-SNUH boramae medical center , Korea (South) Kwang Nam Jin
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Asan Medical Center , Korea (South) Seong Yun Kim
  • - Toyama University Hospital, Laboratory of Pathology , Japan TANAKA TOMONORI
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV
  • - All India Institute of medical sciences , India Justin Moses
  • - Dongguk University International Hospital , Korea (South) Ah-young Kim
  • - hospital , Saudi Arabia fayad alchami
  • - KMC,Manipal , India satish maddukuri
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - CHU Nancy , France Sab Ariane
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - CH de la C�te Basque , France Paul ARDILOUZE
  • - Hopital du Sacr� Coeur , Canada Abraham Bohadana
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - chp st martin , France Mariotte benoit
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Sacr�-Coeur , Canada Andrea Ojanguren
  • - CHU Grenoble , France Fabrice Bing
  • - CHR ANNECY FRANCE , France anne-line MORONI
  • - KING KHALID UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
▶ Correct Answer as Differential Diagnosis : 14/103,  13.6%
  • - Assam medical college , India Karunakaran M
  • - SMC , Korea (South) Jihoon Cha
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - National Taiwan University Hospital, Traumatology , Taiwan Chin-Chung Shu
  • - care hospital , India Chary D
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - CHU nancy Brabois , France Cl�ment Proust
  • - NASA SCANS , India RAKESH BHATIA
  • - vinayaka missions medical college , India k bhaskar
▶ Semi-Correct Answer : 15/103,  14.6%
  • - Teleradiology solutions , India harish bhambore
  • - Dong-A university hospital , Korea (South) Sang-yun LEE
  • - Kangnam severance hospital , Korea (South) Song Min
  • - Gangnam Severance Hospital , Korea (South) Min Jeong Kim
  • - KING KHALID UNIVERSITY HOSPITAL,RIYADH , Saudi Arabia NABIL GHALEB
  • - ROK air force aerospacemedical center , Korea (South) Daekeon Lim
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - ROHINI Scan Centre RSC. Ambattur, Chennai , India Umapathi Mahesh
  • - Hospital M�e de Deus , Brazil Thiago Bento da Silva
  • - Goa Medical College , India Paresh Desai
  • - Barnard Institute of Radiology , India Bhuvaneswaran Natarajan
  • - Institute of Chest Diseases,Calicut , India sijith raghavan
  • - CHRU LILLE , France Vittorio Pansini
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