대한흉부영상의학회 Weekly Chest Cases

Courtesy of Yu-Whan Oh, M.D. / Korea University Hospital, Seoul, Korea
Age/Sex 58 / F
Chief ComplaintIntermittent dyspnea for 1 year, recent aggravation. Pacemaker for atrial fibrillation.

Diagnosis: Hypersensitivity Pneumonitis
Radiologic Findings: Chest radiograph shows diffuse haziness in both lower lung zones. Pacemaker was placed for atrial fibrillation in left chest wall. Inspiratory high-resolution CT scans show areas of varying attenuation in both lungs, including ground-glass attenuation, normal lung, and areas of low attenuation due to mosaic perfusion (head-cheese sign). Ill-defined centrilobular nodules are also noted. Expiratory HRCT scan obtained at the same level as the first inspiratory CT image shows a marked accentuation in attenuation inhomogeneities due to air-trapping.
Transbronchial lung biopsy revealed the areas of interstitial inflammation and ill-defined granuloms, findings consistent with hypersensitive pneumonitis (HP). No specific drug medication history to explain the lung lesion was found. She had worked at the texture company for 2 years. Even though no specific causative agent was found, the diagnosis of HP was made by combining the clinical and pathological findings.
Brief Review: Please refer to the discussion of case 59.
References
Keywords: Lung, Inhalation and aspiration disease, HP,

대한흉부영상의학회 Korean Society of Thoracic Radiology