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


==Overview==
==Overview==
In acute eosinophilic pneumonia (AEP), Pulmonary function tests show reduced [[forced vital capacity]] and [[total lung capacity]] with a normal forced expiratory volume in one second; [[Diffusion capacity|diffusing capacity]] for [[carbon monoxide]] ([[DLCO]]) is commonly reduced. [[Bronchoalveolar lavage]] (BAL) is performed in the majority of patients to exclude [[infection]], [[hemorrhage]], or [[malignancy]]. The [[Bronchoalveolar lavage|BAL]] is performed using a sequential instillation and recovery of 50 to 60 mL. The median BAL cellularity was 350,000/mm3. BAL [[eosinophilia]] was present in all cases with a median of 38%. Lung biopsy is rarely necessary to make a diagnosis of AEP in [[immunocompetent]] patients with a compatible history and prominent [[Bronchoalveolar lavage|BAL]] [[eosinophilia]] in the absence of [[infection]] or other known precipitant.
==Other diagnostic studies==
==Other diagnostic studies==
'''Pulmonary function tests'''
'''Pulmonary function tests'''<ref name="pmid8982150">{{cite journal| author=Pope-Harman AL, Davis WB, Allen ED, Christoforidis AJ, Allen JN| title=Acute eosinophilic pneumonia. A summary of 15 cases and review of the literature. | journal=Medicine (Baltimore) | year= 1996 | volume= 75 | issue= 6 | pages= 334-42 | pmid=8982150 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8982150  }}</ref>
* it is often not possible to obtain pulmonary function tests.<ref name="pmid8982150">{{cite journal| author=Pope-Harman AL, Davis WB, Allen ED, Christoforidis AJ, Allen JN| title=Acute eosinophilic pneumonia. A summary of 15 cases and review of the literature. | journal=Medicine (Baltimore) | year= 1996 | volume= 75 | issue= 6 | pages= 334-42 | pmid=8982150 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8982150  }}</ref>
* A restrictive process may be noted: Reduced [[forced vital capacity]] and [[total lung capacity]] with a normal forced expiratory volume in one second; [[Diffusion capacity|diffusing capacity]] for [[carbon monoxide]] ([[DLCO]]) is commonly reduced.<ref name="pmid8339639">{{cite journal| author=Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S| title=Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia. | journal=Chest | year= 1993 | volume= 104 | issue= 2 | pages= 493-6 | pmid=8339639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8339639  }}</ref>
* a restrictive process may be noted (reduced forced vital capacity [FVC] and total lung capacity with a normal forced expiratory volume in one second [FEV<sub>1</sub>]/FVC); diffusing capacity for carbon monoxide (DLCO) is commonly reduced.<ref name="pmid8339639">{{cite journal| author=Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S| title=Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia. | journal=Chest | year= 1993 | volume= 104 | issue= 2 | pages= 493-6 | pmid=8339639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8339639  }}</ref>
'''Bronchoscopy with bronchoalveolar lavage'''
'''Bronchoscopy with bronchoalveolar lavage'''
* [[Bronchoalveolar lavage]] (BAL) is performed in the majority of patients to exclude infection, hemorrhage, or malignancy.<ref name="pmid8181338">{{cite journal| author=Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M| title=A clinical study of idiopathic eosinophilic pneumonia. | journal=Chest | year= 1994 | volume= 105 | issue= 5 | pages= 1462-6 | pmid=8181338 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8181338  }}</ref>  
* [[Bronchoalveolar lavage]] (BAL) is performed in the majority of patients to exclude [[infection]], [[hemorrhage]], or [[malignancy]].<ref name="pmid8181338">{{cite journal| author=Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M| title=A clinical study of idiopathic eosinophilic pneumonia. | journal=Chest | year= 1994 | volume= 105 | issue= 5 | pages= 1462-6 | pmid=8181338 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8181338  }}</ref>  
* The BAL is performed using a sequential instillation and recovery of 50 to 60 mL aliquots in an area of radiographic opacity. Samples are sent for cell count, microbiologic studies, and cytology.
* The BAL is performed using a sequential instillation and recovery of 50 to 60 mL aliquots in an area of radiographic opacity.
* In AEP, the BAL fluid typically shows a very high proportion (>25 percent) and total number of eosinophils.<ref name="pmid83396392">{{cite journal| author=Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S| title=Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia. | journal=Chest | year= 1993 | volume= 104 | issue= 2 | pages= 493-6 | pmid=8339639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8339639  }}</ref>  
* In acute pneumonia, the BAL fluid typically shows a very high proportion (>25 percent) and total number of [[eosinophils]].<ref name="pmid83396392">{{cite journal| author=Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S| title=Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia. | journal=Chest | year= 1993 | volume= 104 | issue= 2 | pages= 493-6 | pmid=8339639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8339639  }}</ref>  
* The median BAL cellularity was 350,000 [210,000-775,000] /mm3. BAL eosinophilia was present in all cases, with a median of 38%.  
* The median BAL cellularity was 350,000/mm3. BAL [[eosinophilia]] was present in all cases with a median of 38%.  
* While data on other cell counts are limited, the proportion of BAL lymphocytes is approximately 10 to 30 percent and the proportion of BAL neutrophils is 1 to 16 percent.  
* The proportion of BAL [[lymphocytes]] is approximately 10 to 30 percent and the proportion of BAL [[neutrophils]] is 1 to 16 percent.  
* The level of eosinophilia returns to normal when the illness resolves.
* The level of [[eosinophilia]] returns to normal when the illness resolves.
'''Lung biopsy'''
'''Lung biopsy'''
* Lung biopsy is rarely necessary to make a diagnosis of AEP in immunocompetent patients with a compatible history and prominent BAL eosinophilia in the absence of infection or other known precipitant.  
* Lung [[biopsy]] is rarely necessary to make a diagnosis of AEP in [[immunocompetent]] patients with a compatible history and prominent BAL eosinophilia in the absence of [[infection]] or another known precipitant.  
* Indications for lung biopsy would include concern about an infectious etiology that could not be quickly excluded by BAL or failure to respond to systemic glucocorticoids.
* Indications for lung biopsy would include concern about an infectious etiology that could not be quickly excluded by BAL or failure to respond to systemic [[glucocorticoids]].


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Pulmonology]]
[[Category:Emergency medicine]]
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Latest revision as of 04:55, 2 March 2018

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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

In acute eosinophilic pneumonia (AEP), Pulmonary function tests show reduced forced vital capacity and total lung capacity with a normal forced expiratory volume in one second; diffusing capacity for carbon monoxide (DLCO) is commonly reduced. Bronchoalveolar lavage (BAL) is performed in the majority of patients to exclude infection, hemorrhage, or malignancy. The BAL is performed using a sequential instillation and recovery of 50 to 60 mL. The median BAL cellularity was 350,000/mm3. BAL eosinophilia was present in all cases with a median of 38%. Lung biopsy is rarely necessary to make a diagnosis of AEP in immunocompetent patients with a compatible history and prominent BAL eosinophilia in the absence of infection or other known precipitant.

Other diagnostic studies

Pulmonary function tests[1]

Bronchoscopy with bronchoalveolar lavage

  • Bronchoalveolar lavage (BAL) is performed in the majority of patients to exclude infection, hemorrhage, or malignancy.[3]
  • The BAL is performed using a sequential instillation and recovery of 50 to 60 mL aliquots in an area of radiographic opacity.
  • In acute pneumonia, the BAL fluid typically shows a very high proportion (>25 percent) and total number of eosinophils.[4]
  • The median BAL cellularity was 350,000/mm3. BAL eosinophilia was present in all cases with a median of 38%.
  • The proportion of BAL lymphocytes is approximately 10 to 30 percent and the proportion of BAL neutrophils is 1 to 16 percent.
  • The level of eosinophilia returns to normal when the illness resolves.

Lung biopsy

  • Lung biopsy is rarely necessary to make a diagnosis of AEP in immunocompetent patients with a compatible history and prominent BAL eosinophilia in the absence of infection or another known precipitant.
  • Indications for lung biopsy would include concern about an infectious etiology that could not be quickly excluded by BAL or failure to respond to systemic glucocorticoids.

References

  1. Pope-Harman AL, Davis WB, Allen ED, Christoforidis AJ, Allen JN (1996). "Acute eosinophilic pneumonia. A summary of 15 cases and review of the literature". Medicine (Baltimore). 75 (6): 334–42. PMID 8982150.
  2. Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S (1993). "Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia". Chest. 104 (2): 493–6. PMID 8339639.
  3. Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M (1994). "A clinical study of idiopathic eosinophilic pneumonia". Chest. 105 (5): 1462–6. PMID 8181338.
  4. Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S (1993). "Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia". Chest. 104 (2): 493–6. PMID 8339639.

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