대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1064 Date 2018-03-19

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  • Courtesy of Min Jae Cha, MD. / Chung-Ang University Hospital
  • Age/Sex 37 / F
  • Chief Complaintchronic cough and fatigue
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Chronic eosinophilic pneumonia
Radiologic Findings
Fig 1. Chest PA shows increased peripheral parenchymal opacity in both upper lobes (Right > Left).
Figs 2-4. Axial and coronal lung window setting of the chest CT scans show nonsegmental areas of ground-glass opacity with peripheral and upper lung zone predominance.

Peripheral eosinophil count was 14900/microL and percentage of eosinophils in the bronchoalveolar lavage (BAL) fluid was 88%.
Brief Review
Chronic eosinophilic pneumonia is an idiopathic condition characterized by chronic and progressive clinical features and specific pathologic findings. The clinical manifestation is usually insidious, and women are more frequently affected than men. Most patients are middle aged, and approximately 50% have asthma.
Peripheral blood eosinophilia is usually mild or moderate but occasionally is severe. Blood eosinophilia is present in 90% of patients. The percentage of eosinophils in the BAL fluid is very high. Histologic examination typically shows accumulation of eosinophils and lymphocytes in the alveoli and interstitium, with interstitial fibrosis.
The imaging findings of chronic eosinophilic pneumonia are characterized by ground-glass and consolidative pulmonary opacities. A peripheral and upper lung distribution is typical and the findings have been described as the photographic negative appearance of classic central pulmonary edema. CT demonstrates typical nonsegmental areas of airspace consolidation or ground-glass opacity with peripheral predominance. CT performed more than 2 months after the onset of symptoms shows linear bandlike opacities parallel to the pleural surface.
Prompt diagnosis is crucial because the response to steroids is excellent. However, unlike in acute eosinophilic pneumonia, clinical relapse occurs in 30
References
1. Jeong YJ et al. Eosinophilic Lung Diseases: A Clinical, Radiologic, and Pathologic Overview. Radiographics 2007; 27:617
Keywords
Lung, Eosinophilic lung disease,

No. of Applicants : 124

▶ Correct Answer : 57/124,  46.0%
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - , Korea (South) HANKYUL KIM
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Soonchunhyang University College of Medicine , Korea (South) GOUN CHOI
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Chungbuk National University Hospital , Korea (South) CHANGHOON OH
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - McGill University / University College London , Canada Ilan Azuelos
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - , Korea (South) YOUNGHUN JEON
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - NTUH , Taiwan KUEI-PIN CHUNG
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Ewha Womans University Medical Center , Korea (South) YOUNGSUN KO
  • - , Korea (South) DAYOUNG KIM
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Kyeongpook National University Hospital , Korea (South) MIN A LEE
  • - Centre Hospitalier Regional de Lanaudiere , Canada Matthieu Storme
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - , Korea (South) JANG SEONG WON
  • - Myongji Hospital , Korea (South) DAE WOONG PARK
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - TB centre kasaragod. , India rikhy krishnan
  • - , Korea (South) DAHYE SHIN
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - , Korea (South) SOL KI KIM
  • - Soonchunhyang University Hospital Seoul , Korea (South) JINAH KIM
  • - , Korea (South) TAE SUN KANG
  • - Private sector , Greece VASILIOS TZILAS
  • - , Iran VAHID SHAH
  • - Grant medical college Mumbai , India VISHWANATH VASANT PUJARI
  • - Hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - Kyemyung University Dongsan Hospital , Korea (South) DONG HYEON KIM
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Samsung Medical Center , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 25/124,  20.2%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - Chonbuk National University Hospital , Korea (South) JAEYEONG JEONG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) HEE SEOK CHOI
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Other , Korea (South) HAYEON LEE
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
▶ Semi-Correct Answer : 18/124,  14.5%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Chonbuk National University Hospital , Korea (South) AHN JI HOON
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Prince Sattam ibn Abdulaziz University hospital , Saudi Arabia ELBAGIR MOHAMED NASSIR
  • - Chonbuk National University Hospital , Korea (South) SANGJIN PARK
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - , India THE GREAT WARRIOR
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - HHS , Canada S LEE
  • - Hospital Espa , Argentina JORGE PICOREL
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Escola Paulista de Medicina , Brazil RENATO MASSON DE ALMEIDA PRADO
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
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