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Weekly Chest CasesArchive of Old Cases

Case No : 163 Date 2000-12-09

  • Courtesy of Eun Ah Kim, MD, Kyung Soo Lee, MD / Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
  • Age/Sex 27 / M
  • Chief ComplaintCoughing and mild dyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Chronic Eosinophilic Pneumonia
Radiologic Findings
CT scans show multifocal patchy subpleural areas of consolidation.
Peripheral halo of ground-glass attenuation is seen around the consolidation.

The findings are consistent with Chronic Eosinophilic Pneumonia or BOOP (bronchiolitis obliterans organizing pneumonia).

The blood eosinophil count of the patient was 1808 /ul (normal=50-500).
Bronchoalveolar lavage showed many eosinophils (above 60%), macrophages (about 30%), neutrophil (about 5%), and lymphocytes (about 5%).
Brief Review
Chronic eosinophilic pneumonia is characterized pathologically by eosinophilic and lymphocytic accumulation in the alveoli and interstitium. Interstitial fibrosis and eosinophilic abscess may be seen. Histologic features of bronchiolitis obliterans organizing pneumonia or low-grade vasculitis may also be present (1).
The symptoms are insidious and continue for at least one month before diagnosis in all patients. They include cough, fever, dyspnea, and weight loss. Peak incidence of the disease is in the fifth decade. Forty percent of patients have associated asthma. Women are more frequently involved than men (two-to-one ratio).
Chest radiograph classically shows bilateral areas of nonsegmental consolidation in a subpleural distribution. This pattern is seen in 60% of cases. Nodules with or without cavitation are present in 20 % of cases. Pleural effusions are rare and observed in less than 10% of patients (2). CT scan also shows subpleural areas of consolidation, demonstrating peripheral dominance more clearly and frequently than chest radiograph. In the early stage of the disease, consolidation is the predominant abnormality on CT, while nodules or reticular densities predominate in later stages (3).
References
1. Kim Y, Lee KS, Choi DC: The spectrum of eosinophilic lung disease: Radiologic findings. J Comput Assist Tomogr 21:920-930,1997
2. Jederlinic PJ, Sicilian L, Gaensler EA: Chronic eosinophilic pneumonia. A report of 19 cases and a review of the literature. Medicine 67:154-162,1988
3. Ebara H, Ikezoe J, Johkoh T, et al: Chronic eosinophilic pneumonia: Evolution of chest radiograms and CT features. J Comput Assist Tomogr 18:737-744,1994
Keywords
Lung, Eosinophilic lung disease,

No. of Applicants : 30

▶ Correct Answer : 22/30,  73.3%
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  • - CHU Nancy-Brabois France Denis Regent
  • - Dong-A universtity hospital Ki-Nam Lee
  • - Gachon Medical School Gil Medical Center Seo Joon Beom
  • - Ospedale di Fabriano, Italy Giancarlo Passarini
  • - Vilvendhan Rajendran
▶ Semi-Correct Answer : 4/30,  13.3%
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