대한흉부영상의학회 Weekly Chest Cases

Case No : 341 Date 2004-05-08

Courtesy of Mi-young Kim, M.D. / Inje University Ilsan paik Hospital, Gyongido, Korea
Age/Sex 61 / M
Chief ComplaintNonproductive cough for 10 days, fever and chillness

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Diagnosis With Brief Discussion

Diagnosis: Chronic hypersensitivity pneumonitis (extrinsic allergic alveolitis)
Radiologic Findings: (a) Chest radiograph shows ill-defined consolidation and diffuse reticulonodular opacities in the lung.
(b) Lung window of HRCT shows diffuse ground glass opacity, peribronchial, subfissural and peripheral consolidation, irregular and linear opacities with mild parenchymal distortion.
Follow up HRCT after 1 month show newly developed ground glass opacities in both lungs with partial resolving of previous consolidation.
Brief Review: Extrinsic allergic alveolitis (EAA) is a disorder in which repeated inhalation of particulate organic antigens causes a predominantly immunologic response in the air-exchange units of the lung.

The diagnosis of EAA is usually based on the characteristic clinical symptoms and signs, together with evidence of exposure and improvement following withdrawal.

Three stages:
1. In the acute stage the chest radiography is occasionally normal.
2. The most common radiographic finding in the acute or subacute stage is small pulmonary nodules, usually 1 to 3 mm. They are almost always bilateral. In the subacute phase the majority of patients have diffuse ground glass opacity and small nodulation on HRCT.
3. The characteristic radiologic changes in the chronic stage are of a scarring process with loss of lung volume, which has a marked (85%) upper lobe predominance. Chronic HRCT changes consist of coarse, irregular, linear opacities with parenchymal distortion.
References: 1. Silver SF, Muller NL, Miller RR, et al. Hypersensitivity pneumonitis: evaluation with CT. Radiology 1989;173:441-445
2. Peter Armstrong. Imaging of diseases of the chest 2nd ed. 541-546.
Keywords: Lung, Inhalation and aspiration disease, HP,

No. of Applicants : 28

▶ Correct Answer : 5/28, 17.9%

- Damascus country hospital, damascus, Syria Mostafa Dakak
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- National Taiwan University Hospital, Taiwan Tan Che Kim
- Southern Illinois university, IL, USA Fadi Layous

▶ Semi-Correct Answer : 13/28, 46.4%

- Air force education & training command Hospital, Korea Hyukwon Chang
- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- Cheongju saint Mary Hospital, Cheongju, Korea Jeong Geun Yi
- CH Lyon sud, France Xavier Riviere
- CHU Nancy-Brabois, France Denis Regent
- Dong-A University Hospital, Korea Ki-Nam Lee
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- National Taiwan University, ROC, Taiwan Sheng-Hsiang Lin
- Royal Melbourne Hospital, Melbourne, Australia Stefan Heinze
- Sharma Clinic, Jaipur, India Dinesh Sharma
- Social Security Hospital, Ankara, Turkey Meric Tuzun

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 341 Date 2004-05-08

Discussion

No. of Applicants : 28