Diffuse Lung Disease: Diffuse Lung Disease |

Don't Trust a Patient By It's Images: Atypical CT Scan Findings for Chronic Eosinophilic Pneumonia FREE TO VIEW

Hammad Arshad, MD; Meilin Young, MD; Tariq Cheema, MD
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Allegheny General Hospital, Pittsburgh, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A198. doi:10.1016/j.chest.2016.02.205
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SESSION TITLE: Diffuse Lung Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Chronic Eosinophilic Pneumonia is a rare pulmonary disorder associated with intense and abnormal eosinophilic infiltrates.

CASE PRESENTATION: A 49 year old male with Past Medical History of Raynaud's disease and remote smoking was evaluated in our office for symptoms of chronic shortness of breadth and non productive cough. His Pulmonary Function Tests were significant for moderate restriction with severe decrement in the diffusion capacity. A CT scan of the chest showed ground glass opacities in the lower lobe with reticulations and traction bronchiactesis suggestive of pulmonary fibrosis. His connective tissue disorder workup was negative and a bronchoscopy with BAL did not reveal any abnormality. He had a subsequent VATS procedure with wedge biopsy from Left lingual and lower lung lobe showing patchy interstitial and alveolar infiltrates with eosinophilic predominance, pseudo DIP reaction and centrilobular fibrosis with no lymphoid nodules. Pt was started on systemic steroids with improvement of his symptoms.

DISCUSSION: Chronic Eosinophilic Pneumonia was first described by Carrington CB, as a chronic variant of Loffler Syndrome in 1969. Its clinical picture is that of a progressive and severe disease with significant respiratory complaints. The typical presentation includes blood eosinophilia, peripherally predominant infiltrate (photographic negative of pulmonary edema) and a BAL eosinophil count of > 25%. Rarely the diagnosis is made on tissue biopsy in the absence of the above mentioned classical triad (1). The histological findings are characterized by interstitial and intra-alveolar eosinophilic infiltrates with minimal fibrosis. Very rarely does the eosinophilic inflammation progress to pulmonary fibrosis (2).

CONCLUSIONS: Chonic Eosinophilic Pneumonic should be entertained in the differential diagnosis of Pulmonary fibrosis as prompt diagnosis and treatment with steroids can result in significant clinical improvement.

Reference #1: Taniguchi H et al; Eosinophilic pneumonia without eosinophil in BAL and blood and diagnosed by open lung biopsy; Nihon Kokyuki Gakkai Zasshi 1999;Oct 37 (10)

Reference #2: Chronic Eosinophilic PNA progressing to lung fibrosis; Eur Respir J 1994;7:1541

DISCLOSURE: The following authors have nothing to disclose: Hammad Arshad, Meilin Young, Tariq Cheema

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