Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Acute eosinophilic pneumonia.
- Radiologic Findings
- He had a history of recent onset tobacco smoking for 2 weeks. For the diagnostic work up, BAL was done. On BAL analysis, the count of eosinophils was 45%.
Chest PA (Fig 1) shows diffuse bilateral hazy opacities and pleural effusion.
Lung setting of the chest CT images (Fig 2-4) show smooth peribronchial interstitial and interlobular septal thickening in both lungs and ground glass attenuation and consolidation in peribronchial and peripheral portion of both lungs.
Mediastinal setting of chest CT images (Fig 5-6) show small amount of bilateral pleural effusion and mild LN enlargement in mediastinum and subcarinal area.
- Brief Review
- Acute eosinophilic pneumonia (AEP) represents a clinical entity that is distinct from other idiopathic eosinophilic lung diseases. Diagnostic criteria include acute febrile illness of less than 5 days of duration; hypoxemia; diffuse alveolar or mixed alveolar-interstitial opacities on chest radiographs; BAL fluid consisting of more than 25% eosinophils; absence of parasitic, fungal, or other infection; prompt and complete response to corticosteroids; and no relapse after discontinuation of corticosteroids. Peripheral blood eosinophils percentages are usually normal, although they become elevated during the subsequent clinical course. Unlike with blood eosinophils, a very high percentage of BAL eosinophils is characteristic of AEP. Patients respond rapidly to high doses of corticosteroids, usually within 24 hrs.
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.
The radiologic differential diagnosis for AEP includes hydrostatic pulmonary edema, adult respiratory distress syndrome or acute interstitial pneumonia, and atypical bacterial or viral pneumonia. However, developing a clinicoradiologic differential diagnosis for AEP is often difficult because initial peripheral blood eosinophil counts are usually normal.
- References
- 1. Daimon T, Johkoh T, Sumikawa H, et al. Acute eosinophilic pneumonia: Thin-section CT findings in 29 patients. Eur J Radiol. 2008:65(3);462-7.
2. Jeong YJ, Kim KI, Seo IJ, et al. Eosinophilic lung diseases: a clinical, radiologic and pathologic overview. Radiographics. 2007:27(3), 617-37.
- Keywords
- Lung, Eosinophilic lung disease,