Eosinophilic pneumonia CT: Difference between revisions

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{{Eosinophilic pneumonia}}
{{Eosinophilic pneumonia}}
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{{CMG}}; {{AE}} {{MAD}}


==Overview==
==Overview==
Characteristic CT findings of CEP include [[Ground glass opacification on CT|ground-glass attenuation]], [[Consolidation (medicine)|consolidation]], [[Nodules]], septal thickening, [[Pleural effusions]], and thickening of bronchovascular bundles.
==CT==
==CT==
* At the onset of AEP, the chest radiograph may show only subtle reticular or ground glass opacities, often with Kerley B lines.  [58,59]
Computed tomography can help characterize the distribution of opacities and guide selection of an area of involvement for [[bronchoalveolar lavage]].<ref name="pmid22599359">{{cite journal| author=Rhee CK, Min KH, Yim NY, Lee JE, Lee NR, Chung MP et al.| title=Clinical characteristics and corticosteroid treatment of acute eosinophilic pneumonia. | journal=Eur Respir J | year= 2013 | volume= 41 | issue= 2 | pages= 402-9 | pmid=22599359 | doi=10.1183/09031936.00221811 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22599359  }}</ref>
* As the disease progresses, bilateral diffuse mixed ground glass and reticular opacities develop [1,2,9,39-42,59] (image 1A-B).
* Isolated ground glass (approximately 25 percent of cases) or reticular (approximately 25 percent of cases) opacities may also be seen on presentation. The distribution of opacities in AEP is diffuse, unlike chronic eosinophilic pneumonia, in which the opacities are typically localized to the lung periphery.
* Small pleural effusions are common (noted in up to 70 percent of patients) and are frequently bilateral [8,45,48].
* High resolution computed tomography (HRCT) scans are not essential to the diagnosis, but can help characterize the distribution of opacities and guide selection of an area of involvement for bronchoalveolar lavage. The HRCT is always abnormal in patients with AEP and is characterized by bilateral, random, and patchy ground-glass or reticular opacities (image 2) [19,60]. Centrilobular nodules and air-space consolidation are seen in approximately 50 and 40 percent, respectively [19].
* In mild cases, the lesions are sparse or localized [41,61]. At the height of the disease process, HRCT reveals ground-glass opacities along the bronchovascular bundles. Pleural effusions, usually bilateral, are present in almost 90 percent.
* bilateral ground-glass areas: common  
* interlobular septal thickening: common
* pleural effusions: can be present in ~80% (range 60-100%) of cases
* thickening of bronchovascular bundles: present in around two-thirds of cases
* air-space consolidation: present in around half of cases
* ill-defined centrilobular nodules: present in around one-third of cases
Characteristic CT findings of CEP include:
* bilateral consolidative opacities and areas of ground-glass attenuation, involving predominantly the peripheral regions of the middle or upper lung zones [43,61-63].
* Common CT findings of ABPA consist of bronchiectasis, mucous plugging, bronchial wall thickening, atelectasis, consolidation, areas of ground-glass attenuation, and upper and central lung predominance [61]. The first three of these findings are the most indicative of ABPA.
* CT findings in AEP include ground-glass attenuation, consolidation, poorly defined nodules, interlobular septal thickening, and pleural effusions (image 7). The triad of interlobular septal thickening, bronchovascular bundle thickening, and pleural effusions are most suggestive of this diagnosis [61].
* CT findings in EGPA [64], drug-induced pulmonary eosinophilia [65], hypereosinophilic syndrome (HES), and simple pulmonary eosinophilia are varied and diverse. Thus, a radiologic diagnosis of these entities is rarely possible [61].


==References==
Characteristic CT findings of CEP include:<ref name="pmid9772920">{{cite journal| author=Marchand E, Reynaud-Gaubert M, Lauque D, Durieu J, Tonnel AB, Cordier JF| title=Idiopathic chronic eosinophilic pneumonia. A clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P). | journal=Medicine (Baltimore) | year= 1998 | volume= 77 | issue= 5 | pages= 299-312 | pmid=9772920 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9772920  }}</ref><ref name="pmid8089322">{{cite journal| author=Ebara H, Ikezoe J, Johkoh T, Kohno N, Takeuchi N, Kozuka T et al.| title=Chronic eosinophilic pneumonia: evolution of chest radiograms and CT features. | journal=J Comput Assist Tomogr | year= 1994 | volume= 18 | issue= 5 | pages= 737-44 | pmid=8089322 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8089322  }}</ref>
{{reflist|2}}
* [[Ground glass opacification on CT|Ground-glass attenuation]]
* [[Consolidation (medicine)|Consolidation]]
* [[Nodules]]
* Septal thickening
* [[Pleural effusions]] 
* Thickening of bronchovascular bundles
* The lesions usually involve the peripheral regions of the middle or upper lung zones.
* The radiologic diagnosis of other causes of eosinophilic lung such as drug-induced pulmonary eosinophilia and hypereosinophilic syndrome is rarely possible.
* Common CT findings of ABPA consist of [[bronchiectasis]], mucous plugging, bronchial wall thickening, [[atelectasis]], [[Consolidation (medicine)|consolidation]], areas of [[Ground glass opacification on CT|ground-glass attenuation]], and upper and central lung predominance.<ref name="pmid10966710">{{cite journal| author=Johkoh T, Müller NL, Akira M, Ichikado K, Suga M, Ando M et al.| title=Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients. | journal=Radiology | year= 2000 | volume= 216 | issue= 3 | pages= 773-80 | pmid=10966710 | doi=10.1148/radiology.216.3.r00se01773 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10966710  }}</ref>


[[Category:Pulmonology]]
[[File:Acute eosinophilic pneumonia.gif|300px|center|thumb|Acute eosinophilic pneumonia shows ground glass opacification (yellow circles) and thickening of bronchovascular bundles (red circles), source: Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 39331]]


[[Category:Emergency medicine]]
[[File:Ezgif.com-optimize.gif|300px|center|thumb|Chronic eosinophilic pneumonia shows ground glass opacification (yellow circles) and thickening of bronchovascular bundles (red circles), source: Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 39331]]


==References==
{{reflist|2}}
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Overview

Characteristic CT findings of CEP include ground-glass attenuation, consolidation, Nodules, septal thickening, Pleural effusions, and thickening of bronchovascular bundles.

CT

Computed tomography can help characterize the distribution of opacities and guide selection of an area of involvement for bronchoalveolar lavage.[1]

Characteristic CT findings of CEP include:[2][3]

Acute eosinophilic pneumonia shows ground glass opacification (yellow circles) and thickening of bronchovascular bundles (red circles), source: Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 39331
Chronic eosinophilic pneumonia shows ground glass opacification (yellow circles) and thickening of bronchovascular bundles (red circles), source: Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 39331

References

  1. Rhee CK, Min KH, Yim NY, Lee JE, Lee NR, Chung MP; et al. (2013). "Clinical characteristics and corticosteroid treatment of acute eosinophilic pneumonia". Eur Respir J. 41 (2): 402–9. doi:10.1183/09031936.00221811. PMID 22599359.
  2. Marchand E, Reynaud-Gaubert M, Lauque D, Durieu J, Tonnel AB, Cordier JF (1998). "Idiopathic chronic eosinophilic pneumonia. A clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P)". Medicine (Baltimore). 77 (5): 299–312. PMID 9772920.
  3. Ebara H, Ikezoe J, Johkoh T, Kohno N, Takeuchi N, Kozuka T; et al. (1994). "Chronic eosinophilic pneumonia: evolution of chest radiograms and CT features". J Comput Assist Tomogr. 18 (5): 737–44. PMID 8089322.
  4. Johkoh T, Müller NL, Akira M, Ichikado K, Suga M, Ando M; et al. (2000). "Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients". Radiology. 216 (3): 773–80. doi:10.1148/radiology.216.3.r00se01773. PMID 10966710.

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