대한흉부영상의학회 Weekly Chest Cases

Case No : 1249 Date 2021-09-28

Courtesy of Mi Jung Park, Kyung Nyeo Jeon / Gyeongsang National University
Age/Sex 46 / M
Chief ComplaintCC; Nasal obstruction for 1 week Past history; Asthma

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Diagnosis With Brief Discussion

Diagnosis: Eosinophilic granulomatosis with polyangitis (EGPA)
Radiologic Findings: Fig. 1. Chest posteroanterior radiograph showing subtle ground-glass opacities in both lower lobes.
Figs. 2 and 3. Chest computed tomography (CT) scan showing bronchial wall thickening, centrilobular nodules, ground-glass opacities, and interlobular septal thickening in both lungs, predominantly in the lower lobes.
Fig. 4. Additional chest CT findings showing a small amount of bilateral pleural effusion and enlarged lymph nodes in both hila.
Fig. 5. Pharyngeal CT scan showing fluid retention and wall thickening in both maxillary sinuses, suggestive of sinusitis.
Brief Review: A 46-year-old man visited our hospital because of nasal obstruction persisting for 1 week. He has had asthma for several years. Leukocytosis and eosinophilia were observed in peripheral blood samples. He was positive for the anti-myeloperoxidase antibody (perinuclear anti-neutrophil cytoplasmic antibody [ANCA]), but negative for the anti-proteinase 3 antibody (cytoplasmic ANCA), IgE M3 (for Aspergillus), and IgE P4 (for Anisakis). An eosinophil level of 65% was found on differential cell count of bronchoalveolar lavage fluid. Microscopic hematuria was detected in urine. The patient was diagnosed with glomerulonephritis with eosinophilic infiltration on renal biopsy.
Eosinophilic granulomatosis with polyangiitis (previously known as Churg-Strauss syndrome) has been defined as the presence of eosinophil
Please refer to
References: 1) Imaging of Pulmonary Vasculitis Radiology 2010 255:2, 322-341
2) Respiratory manifestations of eosinophilic granulomatosis with polyangiitis (Churg
Keywords

No. of Applicants : 91

▶ Correct Answer : 68/91, 74.7%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan HIROAKI ARAKAWA
- , Japan JUN KANZAWA
- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Showa General Hospital , Japan MASAFUMI KAIUME
- Mayo Clinic , United States AKITOSHI INOUE
- Other , Korea (South) HYEJIN YANG
- Dhq hospital faisalabad , Pakistan AMMAR AHMED
- , Korea (South) HYEYOUNG CHOI
- Other , Korea (South) MINGI SHIN
- CHCB , France LE GUEN RAPHAEL
- Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
- NIMS, HYDERABAD , India BHASKAR K
- IRSA LA ROCHELLE , France JEAN LUC BIGOT
- National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
- , Italy PAOLO BALDASSARI
- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- , Japan CHIAKI SATO
- Chungbuk National University Hospital , Korea (South) JIYUN KANG
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Hallym University Dongtan Medical Center , Korea (South) KYOUNG YEON LEE
- Other , Korea (South) SEONGSU KANG
- Inje University Pusan Paik Hospital , Korea (South) DA SOM KIM
- , China FANG YING GEN
- Muhimbili National Hospital , Tanzania FREDERICK RICHARD LYIMO
- university of montreal , Canada Andrei Bogdan Gorgos I
- Osaka University , Japan AKINORI HATA
- Shimada General Medical Center , Japan HAYATO NOZAWA
- National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
- , Korea (South) HYEWON CHOI
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
- Yeungnam University Medical Center , Korea (South) JONGSOO PARK
- Gifu University Hospital , Japan Yo Kaneko
- , Japan KANAE TAKAHASHI
- McGill , Canada MUTAZ ADNAN KHAIRO
- Asan Medical Center , Korea (South) JIEUN KIM
- Kyoto University Hospital , Japan YASUHISA KURATA
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- , Korea (South) EUNJIN LEE
- Other , Korea (South) SEUNGHYUN LIM
- Osaka City General Hospital , Japan SHU MATSUSHITA
- Chungbuk National University Hospital , Korea (South) MIHYEON PARK
- Other , Korea (South) MINSU KIM
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- , Korea (South) YEJIN JEON
- Seoul Veterans Hospital , Korea (South) SEONG WON JANG
- Other , Korea (South) KYU-CHONG LEE
- , Spain SANDRA DAZ CANALS
- Kyoto University Hospital , Japan SATOSHI IKEDA
- Samsung Medical Center , Korea (South) SUHO KIM
- Toranomon Hospital , Japan KAORU SUMIDA
- Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
- , Japan KAZUMA TERAUCHI
- Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
- National Center for Global Health and Medicine , Japan TOMOKI IMOKAWA
- Private sector , Greece VASILIOS TZILAS
- , Japan YUKI HAYASHI
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
- Kyoto university , Japan AKIHIKO SAKATA
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 5/91, 5.5%

- , United Kingdom SAMSON KADE
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
- Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
- Hanyang University Hospital , Korea (South) SEUNG JIN YOO

▶ Semi-Correct Answer : 2/91, 2.2%

- Scans world , India PHILSON JOSEPH MUKKADA
- MacKay Memorial Hospital, Taipei , Taiwan SHENG-YEH SHEN

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 1249 Date 2021-09-28

Discussion

No. of Applicants : 91