대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Hypereosinophilic syndrome

Radiologic Findings

Chest radiograph shows several vague and hazy opacities on both lungs.
On high-resolution CT scans, several nodules are discrete at peripheral portions in both lungs with surrounding areas of ground-glass appearance.

Hepatic nodules were found on CT and ultrasonography.
Liver biopsy revealed chronic hepatitis with portal fibrosis.
The lobules showed moderate spotty necrosis with lymphocytes and eosinophils.
Eosinophil was 64 % (13,380/ml) on initial differential count of peripheral blood,
and eosinophil was 42.4 % on bone marrow study (normocellular marrow with eosinophilia).
Eosinophilia has been persisted over 6 months.

Brief Review

Hypereosinophilic syndrome (HES, eosinophilic leukemia, disseminated eosinophilic collagen disease, Loeffler's fibroblastic parietal endocarditis) consists of prolonged blood eosinophilia associated with tissue infiltration by eosinophils and multiorgan disease. Seventy percent of patients noted the onset of disease between the age of 20 and 50 years (mean, 33 years). No sex prevalence.

Three criteria have been established:
(1) persistent eosinophilia of 1,500/mm3 for at least 6 months, or death before 6 months in individuals with appropriate signs and symptoms;
(2) lack of evidence for parasitic, allergic, or other recognized cause of eosinophilia; and
(3) signs and symptoms of organ involvement, either directly related to eosinophilia or unexplained in the given setting.

Histologic examination shows infiltration and cuffing of the small pulmonary arteries by eosinophils, associated luminal obliteration can lead to parenchymal infarction.

Initially, chest radiographs may reveal transient hazy opacities or areas of consolidation. CT may demonstrate focal parenchymal abnormalities even in patients who have normal radiographs. Interstitial pattern has been described, presumably caused by perivascular eosinophilic infiltration or fibrosis. Acute eosinophilic pneumonia, which is one of idiopathic eosinophilic lung disease, shows small nodules in peripheral lungs with halo of ground-glass appearance associated with acute illness of fever and dyspnea.

The major cause of morbidity and mortality is cardiac disease (prone to fibrosis of supportive structures of valves. HES must be differentiated from all other causes of peripheral eosinophilia, including rheumatoid disease. The importance of early recognition of the syndrome lies that the prognosis is significantly improved if treatment (steroid and busulfan) is instituted promptly.

References

1. Fraser RS, Muller NL, Colman N, Pare PD. Eosinophilic lung diseases: In Diagnosis of diseases of the chest. Philadelphia: Saunders. 1999: 1748-1751
2. Kang EY, Lee RL, Shim JJ. Pulmonary involvement of hypereosinophilic syndrome: high-resolution CT findings in three patients. JKRS (Korean) 1996: 35(3): 343-345
3. Park CS. Case 16: Acute eosinophilic syndrome, In Thoracic Imaging 1997: Diffuse interstitial lung disease, Korean Society of Thoracic Radiology Vol. 2: 34-35

Keywords

Lung, Eosinophilic lung disease,