대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1244 Date 2021-08-23

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  • Courtesy of Seulgi You, Joo Sun Sun, Kyung Joo Park / Ajou University School of medicine
  • Age/Sex 30 / M
  • Chief ComplaintDyspnea for 1 month, HIV (+)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Subacute hypersensitivity pneumonitis
Radiologic Findings
Fig. 1. Chest posteroanterior radiograph showing numerous small nodular opacities in both lungs.
Figs. 2
Brief Review
Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic disease that is mediated by an inflammatory reaction to inhalation of antigens in susceptible individuals. More than 200 different antigens have been associated with the development of HP, including plant products, animal products, aerosolized microorganisms, and organic chemicals. Most cases of HP develop only after many years of continuous or intermittent inhalation of the inciting agent. HP has been classically divided into acute, subacute, and chronic types according to disease duration at the time of presentation. More recently, it has been divided into fibrotic and nonfibrotic HP.
The common symptoms in both nonfibrotic and fibrotic HP include dyspnea, cough, and chirping rales. Less commonly, constitutional symptoms, such as weight loss and flu-like symptoms, may be present. The onset may be acute or insidious, and the episodes may be recurrent.
The histopathologic process consists of chronic inflammation of the bronchi and peribronchiolar tissue, often with poorly defined granulomas and giant cells in the interstitium or alveoli. Fibrosis and emphysema may develop later.
In nonfibrotic HP, the radiologic findings include diffuse ground-glass opacification, centrilobular ground-glass opacities, air trapping, and lung cysts. These findings are usually bilateral and symmetric with a diffuse distribution. Lung fibrosis and signs of bronchiolar obstruction are highly suggestive of fibrotic HP. Fibrosis manifests as irregular fine or coarse reticulation with architectural lung distortion. Septal thickening, traction bronchiectasis, and honeycombing can occur. Lung fibrosis is most severe in the middle portion of the lungs or equally distributed in the three lung zones with relative basal sparing. Bronchiolar obstruction is also observed in computed tomography as a combination of three patterns (ground-glass opacities, lobules of decreased attenuation and vascularity, and normal-appearing lung).
Removal of the precipitant is often the key to management.
Please refer to
Case 1119, Case 666, Case 462, Case 271, Case 59,
KSTR imaging conference 2018 Spring  Case 8 ,
KSTR Imaging Conference 2016 Spring  Case 10,
References
1. Ganesh Raghu et al., Diagnosis of Hypersensitivity Pneumonitis in Adults An Official ATS/JRS/ALAT Clinical Practice Guideline, Am J Respir Crit Care Med Vol 202, Iss 3, pp e36
Keywords

No. of Applicants : 103

▶ Correct Answer : 14/103,  13.6%
  • - Other , Korea (South) HYEJIN YANG
  • - Other , Korea (South) MINGI SHIN
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - Osaka University , Japan AKINORI HATA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - , Korea (South) EUNJIN LEE
  • - Other , Korea (South) SEUNGHYUN LIM
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - VENKATESHWAR HOSPITAL NEW DELHI , India RAKESH BHATIA
  • - Samsung Medical Center , Korea (South) SUHO KIM
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 31/103,  30.1%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Dhq hospital faisalabad , Pakistan AMMAR AHMED
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Seoul National University Bundang Hospital , Korea (South) SOWON JANG
  • - , Italy PAOLO BALDASSARI
  • - , France CHARLES DAMIEN
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Muhimbili National Hospital , Tanzania FREDERICK RICHARD LYIMO
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) HYEWON CHOI
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KANAE TAKAHASHI
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Other , Korea (South) MINSU KIM
  • - Seoul Veterans Hospital , Korea (South) SEONG WON JANG
  • - Other , Korea (South) KYU-CHONG LEE
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan TOMOKI IMOKAWA
  • - , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - , Korea (South) WONJU HONG
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - algeria , Algeria ZAKARIA CHERAGA
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