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Weekly Chest CasesArchive of Old Cases

Case No : 596 Date 2009-03-30

  • Courtesy of Chul Seung Lee, Choong Wook Lee, Eun Jin Chae, Kyung Hyun Do / University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  • Age/Sex 19 / M
  • Chief ComplaintFever, Cough (developed 1 week ago, aggravated 2 days ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Chest radiography on admission

Diagnosis With Brief Discussion

Diagnosis
Acute eosinophilic pneumonia
Radiologic Findings
Initial chest radiograph shows prominent interstitial marking in both upper lung zones accompanied with ill-defined ground glass opacity in the right upper lobe.
On follow up chest radiograph of 2 days later, the extent of ill-defined patchy consolidations increased rapidly with ground glass opacities in peripheral portion of both upper lung zones.
Initial chest CT scan shows smooth interlobular septal thickening with multifocal patch ground glass opacity in both upper lobes and accompanied subpleural consolidations in both upper and lower lobes. There are small amount of bilateral pleural effusion.

On follow up chest radiograph of 5 days later, previously noted ground glass opacities and consolidations as well as interstitial thickening were markedly improved.
Brief Review
Acute eosinophlic pneumonia is a characteristic disease of diffuse alveolar damage with interstitial and alveolar eosinophil and mononuclear cell infiltration. It shows acute febrile illness lasting 1-5 days accompanied by myalgia, pleuritis chest pain and occasionally hypoxemic respiratory failure. Diagnostic criteria is 1) Acute febrile illness of less than 5 days duration, 2) Hypoxemic respiratory failure (PaO2 < 60mmHg on room air), 3) Diffuse mixed alveolar and interstitial chest radiograph infiltrates, 4) BAL eosinophilia (>25%), 5) No apparent infectious cause, 6) No history of asthma or allergic disease, 7) Rapid and complete response to corticosteroid therapy, 8) No relapse after discontinuation of corticosteroid therapy. Peripheral blood eosinophil count is usually normal, then elevated during clinical course.

Typical radiographic finding is diffuse bilateral reticular opacities with or without patchy consolidation and pleural effusion. On chest CT, it shows findings of bilateral patchy area of ground glass opacity and consolidation accompanied with poorly defined nodules and smooth interlobular septal thickening. Pleural effusion is commonly combined.

Possible differential diagnoses are hydrostatic pulmonary edema, ARDS, AIP, and atypical bacterial or viral pneumonia. But, clinicoradiologic differential diagnosis is often difficult.
References
1. Jeong YJ, Kim KI, Seo IJ et al. Eosinophilic Lung Diseases: A clinical, Radiologic, and Pathologic Overview. RadioGraphics 2007; 27:617-639
2. Cheon JE, Lee KS, Jung GS, Chung MH, Cho YD. Acute eosinophilic pneumonia: Radiographic and CT findings in six patients. AJR 1996; 167:1195-1199
3. Takeshi J, Nostor LM, Masanori A et al. Eosinophilic lung diseases: Diagnostic accuracy of thin section CT in 111 patients. Radiology 2000; 216:773-780
4. King MA, Pope-Harman AL, Allen JN, Christofordis GA, Christoforidis AJ. Acute eosinophilic pneumonia: Radiologic and Clinical features Radiology 1997; 203:715-719


Please refer to
Case 105 Case 128 Case 200 Case 260 Case 480
Keywords
Lung, Pleura, Eosinophilic lung disease,

No. of Applicants : 85

▶ Correct Answer : 41/85,  48.2%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Osaka University , Japan Osamu Honda
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - CHRU lille , France manuel toledano
  • - atatk etim-arama hast. , Turkey kamil yel
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - NHIC Ilsan hospital , Korea (South) Ju Hee Moon
  • - kyungpook national university hospital , Korea (South) jiwon park
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Kyungpook National Univ. Hospital , Korea (South) Sang-yub Lee
  • - WARABI CITY HOSPITAL , Japan YASUO OKUBO
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - CHU caen , France nicolas gautier
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - Samsung Medical Center , Korea (South) Hye Sun Hwang
  • - Daegu Fatima Hospital , Korea (South) Tae-Hun Kim
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - Saboo Hospital , India Sandeep Saboo
  • - SNUBH , Korea (South) Kyoung Jin Oh
  • - Soonchunhyang university hospital BUCHEON , Korea (South) Yang ji yeon
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - DCA, , India Rajesh Gothi
  • - Medical IT Consulting , Japan Kazumasa Nishimura
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
  • - Saga University , Japan Ryoko Egashira
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - CHU Grenoble , France Fabrice Bing
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - SMC , Korea (South) Jihoon Cha
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
▶ Correct Answer as Differential Diagnosis : 12/85,  14.1%
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Seoul National University Hospital , Korea (South) Kwang Nam Jin
  • - hospital Sao Paulo , Brazil israel missrie
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - john h stroger hsp , United States dheeraj reddy gopireddy
  • - Toyama University Hospital, Laboratory of Pathology , Japan TANAKA TOMONORI
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - NASA SCANS , India RAKESH BHATIA
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - IRSA , France jean luc BIGOT
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Semi-Correct Answer : 1/85,  1.2%
  • - tepecik etim arama hastanesi , Turkey ismail uan
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