대한흉부영상의학회 Weekly Chest Cases

Case No : 1040 Date 2017-10-03

Courtesy of Ji Young Rho, MD. / CHA Bundang Medical Center, CHA University
Age/Sex 21 / F
Chief Complaintabrupt onset of fever, chill, and myalgia for 1day / She started smoking 1week prior to the onset of symptoms.

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Diagnosis With Brief Discussion

Diagnosis: Smoking-induced acute eosinophilic pneumonia (AEP)
Radiologic Findings: Chest PA shows diffuse bilateral alveolar and reticular opacities. Lung window setting of the chest CT scan shows multifocal ill-defined ground-glass opacities, interlobularseptal thickening and peribronchovascular interstitial thickening in both lungs. Note the bilateral pleural effusions. Bronchoalveolar lavage (BAL) showed eosinophilia.
Brief Review: Acute eosinophilic pneumonia (AEP) is characterized by an acute febrile onset, progressive respiratory failure, bilateral chest infiltrates, an increase of eosinophils in bronchoalveolar lavage fluid (>25%), and a dramatic response to
corticosteroids. It was first described by Allen and colleagues in 1989, but the exact cause still remains unknown.
Smoking of cigarettes has been proposed as a cause of AEP, with most cases involving young adults who had recently started smoking.
Chest radiograph shows bilateral pulmonary infiltrates, mixed alveolar and reticular opacities, including ground glass opacities. CT chest shows ground-glass opacities, consolidation, nodular opacities and pleural effusion.
References: 1. Bok GH, Kim YK, Lee YM, Kim KU, U ST, Hwang JH, Kim DW. Cigarette smoking-induced acute eosinophilic pneumonia: a case report including a provocation test. J Korean Med Sci 2008;23:134-137.
2. Uchiyama H, Suda T, Nakamura Y, Shirai M, Gemma H, Shirai T, Toyoshima M, Imokawa S, Yasuda K, Ida M, Nakano Y, Inui N, Sato J, Hayakawa H, Chida K. Alterations in smoking habits are associated with acute eosinophilic pneumonia, Chest 2008; 133 :1174-1180.
3. Allen JN, Pacht ER, Gadek JE, Davis WB. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med 1989; 321: 569-574.
4. Watanabe K, Fujimura M, Kasahara K Yasui M, Myou S, Kita T, Watanabe A, Nakao S. Acute eosinophilic pneumonia following cigarette smoking: a case report including cigarette-smoking challenge test. Intern Med 2002; 41: 1016-1020.
5. Shintani H, Fujimura M, Ishiura Y, Noto M. A case of cigarette smoking-induced acute eosinophilic pneumonia showing tolerance. Chest 2000; 117: 277-279.
6. Nakajima M, Manabe T, Niki Y, Matsushima T. Cigarette smoke- induced acute eosinophilic pneumonia. Radiology 1998; 207: 829-831.
Please refer to: Case 929 Case 782 Case 698 Case 652 Case 629 Case 601 Case 596 Case 480 Case 260 Case 200 Case 128 Case 105
Keywords: Acute Eosinophilic Pneumonia, Lung, Eosinophilic lung disease,

No. of Applicants : 99

▶ Correct Answer : 76/99, 76.8%

- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- Gifu University Hospital , Japan TOMOHIRO ANDO
- NIMS, HYDERABAD , India BHASKAR K
- Seoul Medical Center , Korea (South) TAERAN AHN
- The University of Tokyo Hospital , Japan Yusuke Watanabe
- , Korea (South) DONG-HO BANG
- Kyeongpook National University Hospital , Korea (South) CHUNGEUN LIM
- Chonnam National University Hwasun Hospital , Korea (South) INSOO JANG
- Other , Korea (South) SEONG SU KANG
- Asan Medical Center , Korea (South) HYUN JUNG KOO
- Freelance resident in Reunion Island , Reunion Fabien HO
- Amagasaki General Medical Center , Japan GENKI FUKUMOTO
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Samsung Medical Center , Korea (South) JUHYUN KIM
- The Jikei university , Japan TAKU GOMI
- Universidad de Chile , Chile Gonzalo Leopoldo Pereira
- university of montreal , Canada Andrei Bogdan Gorgos I
- Ajou University School of Medicine , Korea (South) YOOLIM BAEK
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Ajou University Hospital , Korea (South) Taeyang Ha
- Asan Medical Center , Korea (South) HONG SANG HYUP
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
- Chonnam National University Hospital , Korea (South) JONG HYEON KIM
- Chung buk national university hospital , Korea (South) hong gwon Byun
- Gifu University Hospital , Japan Yo Kaneko
- Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
- Samsung Medical Center , Korea (South) MIN YEONG KIM
- Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
- , Japan TORU KONISHI
- Samsung Medical Center , Korea (South) KYOWON GU
- Medicheck health care , Korea (South) Chae hun Lim
- 怨紐 , Korea (South) jin young kim
- Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Other , Korea (South) MINKYU KWAK
- Other , Korea (South) HAYEON LEE
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Busan National University Hospital , Korea (South) CHANGMU LEE
- Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
- Maimonides Medical Center , United States NAOMI TWERSKY
- Armed Force Capital Hospital , Korea (South) Dae Kun Oh
- , Korea (South) HYERIN KIM
- Azienda Ospedaliera di Cremona , Italy Pietro Sergio
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Multimagem Diagn泥sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
- Wuhan Union Hospital , China QIGUANG CHENG
- SRMC , India PRABHU RADHAN RADHAKRISHNAN
- The University of Tokyo Hospital , Japan TAKU TAJIMA
- , Korea (South) RANG LEE
- District TB centre, kasaragod,India , India rikhy krishnan
- Korea university medical center, guro hospital , Korea (South) Lee kyu chong
- Tashkent Medical Academy , Uzbekistan Rustam Azimovich Fayzullaev
- University of Cincinnati , United States SANGITA KAPUR
- Ajou University Hospital , Korea (South) SEULGI YOU
- Kizawa Memorial Hospital , Japan Shoji Okuda
- Ajou University Hospital , Korea (South) SUBIN HEO
- Teikyo University Hospital , Japan KAORU SUMIDA
- Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Seoul National University Hospital , Korea (South) YONGSUB SONG
- University of Tsukuba , Japan Toshitaka Ishiguro
- Private sector , Greece VASILIOS TZILAS
- Pusan national university hospital , Korea (South) Jin Joo Kim
- University of Utah , United States AKIHIKO SAKATA
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Pusan national university hospital , Korea (South) So min Park
- Chungbuk National University Hospital , Korea (South) HYEONMI RYU
- , Japan YOSHITAKA UEDA
- , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 4/99, 4.0%

- McGill University Health Center , Canada Alexandre Semionov
- Chonnam national university hospital , Korea (South) GYEONG IL MOON
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA

▶ Semi-Correct Answer : 3/99, 3.0%

- Pusan national university hospital , Korea (South) MIRI JEONG
- University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1040 Date 2017-10-03

Discussion

No. of Applicants : 99