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Weekly Chest CasesArchive of Old Cases

Case No : 806 Date 2013-04-08

  • Courtesy of Tae Jung Kim / Seoul National University Bundang Hospital
  • Age/Sex 54 / M
  • Chief Complaintfever and cough for two weeks
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Initial chest radiograph

Diagnosis With Brief Discussion

Diagnosis
Chronic Eosinophilic Pneumonia
Radiologic Findings
Initial chest radiograph shows multifocal patchy and ill-defined airspace consolidation in the upper lungs with peripheral predominance, which is typical of photographic negative shadow of pulmonary edema in chronic eosinophilic pneumonia.
CT scan also shows multifocal non-segmental airspace consolidation primarily involving the upper and peripheral lung.
Brief Review
The patient had eosinophilia in the peripheral blood (19%) and BAL fluid (59%), which was normalized after methyl prednisolone medication. The patient had no history of asthma.
CEP is an idiopathic condition characterized by chronic and progressive clinical features and specific pathologic findings. The clinical manifestation is usually insidious, and the patient experiences symptoms for an average of 7.7 months before the diagnosis is made. Most patients are middle aged, and approximately 50% have asthma. Women are more frequently affected than men. Pulmonary function tests can be normal in mild cases but usually show restrictive defects. Peripheral blood eosinophilia is usually mild or moderate but occasionally is severe. The percentage of eosinophils in the BAL fluid is very high. Histologic examination typically shows accumulation of eosinophils and lymphocytes in the alveoli and interstitium, with interstitial fibrosis. An organizing pneumonia pattern or an eosinophilic abscess may also be seen. The essential histologic differences between AEP and CEP are related to the severity of damage to the basal lamina, and the amount of subsequent intraluminal fibrosis. The typical chest radiographic finding in CEP is nonsegmental peripheral airspace consolidation ('photographic negative shadow of pulmonary edema') involving mainly the upper lobes. However, this finding may be seen in less than 50% of cases. CT demonstrates typical nonsegmental areas of airspace consolidation with peripheral predominance. Less common findings include ground-glass opacities, nodules, and reticulation. These less common findings predominate in the later stages of CEP. CT performed more than 2 months after the onset of symptoms shows linear bandlike opacities parallel to the pleural surface. Pleural effusion is observed in less than 10% of cases.
References
Jeong YJ, Kim K-I, Seo IJ, et al. Eosinophilic lung disease: a clinical, radiologic, and pathologic overview. Radiographics 2007. 27:617-637
Please refer to
Case 163 Case 281 Case 323 Case 369
Keywords
Lung, Eosinophilic lung disease,

No. of Applicants : 101

▶ Correct Answer : 58/101,  57.4%
  • - Osaka university , Japan Akio Tsukabe
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - SNUH , Korea (South) Euijin Hwang
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - McGill University Health Center , Canada Alexandre Semionov
  • - AFCH , Korea (South) Bongwan Noh
  • - Montreal , Canada Drago Le King
  • - UWO , Canada S Lee
  • - ICD,MCH CALICUT , India rikhy krishnan
  • - ewgettu , Egypt koko kamar
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - DCA, , India Rajesh Gothi
  • - , Korea (South) park ji hoon
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - universidad de chile , Chile enrique aguilera
  • - humiic , Korea (South) Ju Won Lee
  • - Pulmonary Institute, Shaare Zedek Medical Center , Israel Abraham Bohadana
  • - Maimonides Medical Center , United States naomi twersky
  • - Centre Hospitalier Lyon Sud , France matthieu ROUSSET
  • - , Korea (South) Kim Soo-Yeon
  • - Chonnam national univ. hospital , Korea (South) Choi Seul-Gi
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Chonnam national university hospital , Korea (South) SeungJin Lee
  • - University of British Columbia , Canada Amr Ajlan
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Universit , Belgium Benoit Ghaye
  • - Chungnam National University hospital , Korea (South) sunkyoung you
  • - Korea university , Korea (South) Kun Woo Kang
  • - SKG radiology , Australia Yuranga Weerakkody
  • - Cheonan soonchunhyang university hospital , Korea (South) Yu Sung Yoon
  • - Severance hospital, shinchon , Korea (South) yeojin lee
  • - TCM HOSPITAL OF ZIGONG , China Cao Cunyou
  • - Kovai Medical Centre Hospital, Coimbatore, India , India Krishna Prasad Bellam
  • - Myongji hostipal , Korea (South) Yongsuk Jang
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - chungbuk national university hospital , Korea (South) jeehye kim
  • - 異⑸ , China ZHANG YING
  • - Chungbuk national university hospital , Korea (South) Jisun Lee
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - NDMVP Nashik , India Imran Jindani
  • - Saint Malo , France jean-baptiste Noel
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - chp st martin , France Mariotte benoit
  • - CAC Rennes , France nicolas gautier
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Private sector , Greece Vasilios Tzilas
  • - Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - NASA SCANS , India RAKESH BHATIA
  • - Vikram hospital , India Pravin Mahadevappa
▶ Correct Answer as Differential Diagnosis : 20/101,  19.8%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - GHTM ,STANLEY MEDICAL COLLEGE,CHENNAI , India siva raja
  • - radiologist, aditya imaging centre , India vivek patel
  • - Kyoto University , Japan Akihiko Sakata
  • - GHICL , France manuel toledano
  • - SRM medical college , India ram s
  • - Mashhad University of Medical Sciences , Iran Bita Abbasi
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Dongtan Sacred Heart Hospital , Korea (South) Younghwan Ko
  • - kasturba medical college , India mugil varman
  • - sahyadri speciality hospital , India kothareddy dileepreddy
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - McGill university , Canada Badriya Al-Qassabi
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - All India Institute of medical sciences , India Justin Moses
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Okayama university , Japan Mayu Uka
▶ Semi-Correct Answer : 4/101,  4.0%
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - CHU Poitiers , France CHAN paul
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
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