대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1346 Date 2023-08-07

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  • Courtesy of Jung Han Woo, Tae Jung Kim / Samsung Medical Center
  • Age/Sex 49 / F
  • Chief Complaintno response of consolidative lung lesion to 5days of antibiotics
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
IgG4-related lung disease
Radiologic Findings
Fig 1. Chest PA shows diffuse mass-like consolidations in RULZ, RLLZ and LLLZ
Fig 2-4. CT scans reveal multifocal nodular consolidations in subpleural and peribronchial area with CT angiogram sign, and enlarged LNs in subcarinal, paratracheal areas
Fig 5. Strong FDG uptake (SUVmax: 14) in the lung lesions and enlarged LNs
Brief Review
IgG4-related lung disease
:Fibro-inflammatory condition that can affect multi-organs

Pathology : Diffuse lymphoplasmacytic infiltration with fibrosis
No necrosis or granulomatous inflammation
Serum IgG4 level is correlated with disease activity

Parenchymal : nodule/masses, interstitial lung disease
Airways : tracheobronchial stenosis
Pleural : nodules/effusion
Mediastinal :lymphadenopathy, fibrosing mediastinitis

Image findings: parenchymal types
Solid nodular type
Round GGO type
Alveolar interstitial type
Bronchovascular type
References
Respirology, Volume18, Issue3 April 2013 Pages 480-487
BMC Pulmonary Medicine volume 16, Article number: 20 (2016)
La radiologia medica volume 124, pages 1262
Keywords

No. of Applicants : 85

▶ Correct Answer : 1/85,  1.2%
  • - Other , Korea (South) SEONGSU KANG
▶ Correct Answer as Differential Diagnosis : 19/85,  22.4%
  • - , Japan HIROAKI ARAKAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Chonnam National University Hwasun Hospital , Korea (South) DONGHUN HAN
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Hukuda memorial hospital , Japan SHINTARO KANO
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Seoul National University Hospital , Korea (South) SUNGHO HONG
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , Korea (South) JIN WOO YOON
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