대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1322 Date 2023-02-21

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  • Courtesy of Chan Ho Park, Young Tong Kim / Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine
  • Age/Sex 19 / M
  • Chief ComplaintDyspnea, fever, cough for 3 days / started smoking 3 weeks ago
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Acute eosinophilic pneumonia (AEP)
Radiologic Findings
Fig 1. Chest radiograph shows diffuse irregular patchy opacities and increased interstitial markings in both lungs.
Fig 2-6. CT scan reveals multifocal ill-defined ground-glass opacities (GGO) with interlobular septal thickening in both lungs.
Bronchoalveolar lavage (BAL) showed 57% eosinophilia
Brief Review
1. Cause - majority of cases are idiopathic
- Tobacco smoke be a trigger for AEP, especially in new-onset smokers
2. CT findings - Bilateral patchy GGO and consolidation
- Poorly ill-defined nodules
- Interlobular septal thickening
3. Diagnosed when the following combination clinical and radiographic findings
1) Acute febrile illness of less than 5 days duration
2) Hypoxemia
3) Diffuse alveolar or mixed alveolar-interstitial opacities
4) BAL fluid consisting of more than 25% eosinophils
5) Peripheral blood eosinophil percentages - usually normal
6) Absence of parasitic, fungal, or other infection
7) Prompt and complete response to corticosteroids
8) No relapse after discontinuation of corticosteroids
References
1. Yeon Joo Jeong, et al. Eosinophilic lung diseases : A Clinical, Radiologic and Pathologic Overview. Radiographics 2007; 27: 617-639.
Keywords

No. of Applicants : 104

▶ Correct Answer : 90/104,  86.5%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Chonnam National University Hwasun Hospital , Korea (South) KWANGKUN CHO
  • - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - , Japan HIROAKI ARAKAWA
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - , Japan MASAKI UMEHANA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - , France ANNE-LAURE LEJEUNE
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Seoul National University Hospital , Korea (South) HYUNGIN PARK
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Other , Korea (South) HWANGHEE JO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Sotira Hospital , Greece EVANGELIA KOUKAKI
  • - Korea University Guro Hospital , Korea (South) YEJU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - , United Arab Emirates GAYATHRI GANAPATHY
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Osaka University , Japan AKINORI HATA
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - , Japan HIKARI FUKUI
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) MINJI KIM
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - , Japan YUKIKO USUI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) JAYOUNG MOON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Hukuda memorial hospital , Japan SHINTARO KANO
  • - , Japan KENTARO KOTANI
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Other , Korea (South) CHAEHUN LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Korea University Guro Hospital , Korea (South) LEE DAKYONG
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Other , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Manipal hospital Hebbal, Bengaluru , India PRAVIN KUMAR M
  • - Seoul National University Hospital , Korea (South) SUNGHO HONG
  • - Others , India PURUSHOTHAMA RAO TUMMALA
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kyoto University , Japan SHO KOYASU
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Chonnam National University Hospital , Korea (South) SOMIN LEE
  • - Chungbuk National University Hospital , Korea (South) HYE SOO CHO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Other , Korea (South) DONG HAN SHIN
  • - Chonbuk National University Hospital , Korea (South) SEOYUN CHOI
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Japan YUMI MAEHARA
  • - Shiga University of Medical Science , Japan RYO UEMURA
  • - , Japan NOBUYUKI OTANI
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - , Japan YUKI HAYASHI
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - , Korea (South) WONJU HONG
  • - , Korea (South) HM PARK
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , Korea (South) JIN WOO YOON
  • - Juntendo University , Japan YUTAKA IKENOUCHI
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 2/104,  1.9%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
▶ Semi-Correct Answer : 2/104,  1.9%
  • - CHCB , France LE GUEN RAPHAEL
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
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