대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 737 Date 2011-12-12

  • Courtesy of Sun-Wha Song / The Catholic University of Korea, Uijeongbu St. Mary’s Hospital
  • Age/Sex 21 / M
  • Chief ComplaintFever and cough for 1 week
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Mycoplasma pneumoniae Pneumonia
Radiologic Findings
Chest CT images (Figure 1-3) show bronchial wall thickening, centrilobular nodules, ground-glass opacities or consolidations with lobular distribution, thickening of the axial interstitium and interlobular septa and small both pleural effusion.Chest radiograph (Figure 4) shows diffuse patchy or nodular ground glass opacities, multiple linear opacities, and small both pleural effusion.
Brief Review
Mycoplasma pneumoniae Pneumonia is common cause of community-acquired pneumonia. M. pneumoniae infection is typically a disease of children and young adults; however, it is estimated to cause more than 25% of pneumonias in patients older than 40 years. The target of this organism is regarded to be the ciliated cells of the respiratory tract, while it is characterized by acute cellular bronchiolitis with edematous and ulcerative lesions of the bronchial walls, and by peribronchial and perivascular interstitial opacities containing lymphocytes, plasma cells, and macrophages. The alveoli surrounding involved bronchioles contain a mononuclear cell infiltration. Histologically, characteristic acute cellular bronchiolitis may progress to bronchopneumonia. The most common findings on radiography is the presence of air-space opacification which is patchy and segmental or nonsegmental in distribution. On CT, bronchial wall thickening is seen most frequently (81%), followed by centrilobular nodules (78%), ground-glass attenuation (78%) and consolidation (61%) of a lobular distribution. Thickening of the axial interstitium and interlobular septa is commonly seen. The lobular distribution, centrilobular nodules, and interstitial abnormalities in M. pneumoniae Pneumonia are often difficult to recognized on radiography but can usually be seen on high-resolution CT. Other findings are pleural effusion and lymphadenopathy. The CT findings in adult patients consisted of a mixture of a bacterial bronchopneumonia pattern and a viral interstitial pneumonia pattern. But M. pneumoniae Pneumonia in children is similar to that of bacterial lobar pneumonia.
References
1. Okada F, Ando Y, Wakisaka M, Matsumoto S, Mori H. Chlamydia pneumoniae pneumonia and Mycoplasma pneumoniae Pneumonia: comparision of clinical findings and CT findings. JCAT 2005;29:626-632
2. Reittner P, Muller NL, Heyneman L, et al. Mycoplasma pneumoniae Pneumonia: radiographic and high-resolution CT features in 28 patients. AJR 2000;174:37-41.
3. Lee I, Kim TS, Yoon HK. Mycoplasma pneumoniae Pneumonia: CT features in 16 patients. Eur Radiol 2006;16:719-725.
Keywords
lung, infection, bacterial,

No. of Applicants : 87

▶ Correct Answer : 16/87,  18.4%
  • - Japanese Red Cross Society Himeji Hospital , Japan Yuichiro Kanie
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Jeju national university hospital , Korea (South) Jeong sub Lee
  • - UWO , Canada S Lee
  • - CHU de Bordeaux , France Fran�ois Laurent
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Asan Medical Center , Korea (South) Bohyun Kim
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - Asan Medical Center , Korea (South) Eun Jin Chae
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Korea University Ansan hosipital , Korea (South) Doran Hong
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - All India Institute of medical sciences , India Justin Moses
▶ Correct Answer as Differential Diagnosis : 22/87,  25.3%
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - University of British Columbia , Canada Amr Ajlan
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - GRMC (Gajra raja medical college), deptt. of radiodiagnosis gwalior , India SHAILESH GUPTA
  • - Kyung Hee University Hospital , Korea (South) Ji Jang
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Montreal Chest Institute , Canada Faiz Kham
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - IRSA , France jean-luc BIGOT
  • - CHRU Lille , France Paul Lebert
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - XiangYa hospital , China yu xia
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Korea university , Korea (South) Kun Woo Kang
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Private sector , Greece Vasilios Tzilas
  • - Okayama university , Japan Mayu Uka
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