Acute eosinophilic pneumonia: Thin-section CT findings in 29 patients

doi:10.1016/j.ejrad.2007.04.012

European Journal of Radiology

Volume 65, Issue 3, March 2008, Pages 462-467

https://doi.org/10.1016/j.ejrad.2007.04.012 Get rights and content

Abstract

Purpose

To determine thin-section computed tomography (CT) characteristics of acute eosinophilic pneumonia (AEP).

Materials and methods

Thin-section CT scans of 29 patients (14 males, 15 females; mean age, 26 ± 15 years; age range, 15–72 years) with AEP were included this retrospective study. The clinical diagnosis of AEP was established by Allen's criteria. Each thin-section CT was reviewed by two observers.

Results

Bilateral areas with ground-glass attenuation were observed on thin-section CT in all patients. Areas of air-space consolidation were present in 16 (55%) of 29 patients. Poorly defined centrilobular nodules were present in 9 patients (31%). Interlobular septal thickening was present in 26 patients (90%). Thickening of bronchovascular bundles was present in 19 patients (66%). Pleural effusions were present in 23 patients (79%) (bilateral = 22, right side = 1, left side = 0). The predominant overall anatomic distribution was central in only 2 (7%) of 29 patients, peripheral in 9 patients (31%), and random in 18 patients (62%). The overall zonal predominance was upper in 4 patients (14%), lower in 8 patients (28%), and random in 17 patients (58%).

Conclusion

CT findings in AEP patients consisted mainly of bilateral areas of ground-glass attenuation, interlobular septal thickening, thickening of bronchovascular bundles, and the presence of a pleural effusion without cardiomegaly. The most common overall anatomic distribution and zonal predominance of the abnormal CT findings were random.

Introduction

The concept of acute eosinophilic pneumonia (AEP) was first suggested by Allen et al. in 1989 [1]. AEP has an acute onset and the time from onset to the peak of disease is usually less than a week. Patients present with respiratory insufficiency, hypoxemia, fever, diffuse pulmonary infiltrates, increased eosinophil count (>25%) on bronchoalveolar lavage (BAL), and no evidence of infection or previous atopic illness. AEP is also characterized by a rapid response to corticosteroids with no relapses and improvement of radiographic abnormalities without fibrosis [1], [2]. Some case reports have stated that inhalation of various materials could provoke AEP [3], [4], [5], [6]. Currently, researchers, particularly Japanese investigators, consider that cigarette smoking is an important causative agent of AEP [7], [8], [9], [10].

Characteristic chest X-ray findings of AEP have been reported, including bilateral diffuse areas with ground-glass attenuation, smooth interlobular septal thickening, defined nodules, and pleural effusion without cardiomegaly [11], [12], [13], [14]. However, these studies are based on only a small number of AEP patients and their CT findings were incompletely characterized with respect to their anatomic distribution and zonal predominance. The aim of this study was to determine the characteristic findings on thin-section CT of AEP patients, with particular attention to the distribution of the various abnormal findings.

Section snippets

Study population

Twenty-nine consecutive patients who had a definitive diagnosis of AEP and had thin-section CT at our six institutions in the previous 15 years were entered into the study. The patients included 14 males and 15 females, aged 26 ± 15 years (mean ± S.D.) (range: 15–72 years). The institutional review board gave full approval and waived informed consent for our retrospective study.

All patients fulfilled Allen's diagnostic criteria as mentioned in Section 1[2], and all cases had pulmonary infiltration

Results

Interobserver agreement for all of the abnormalities noted on CT images was moderate to excellent (κ = 0.41–1.0) (Table 1). There was fair to moderate interobserver agreement with respect to the predominant overall anatomic distribution (κ = 0.25–0.53) (Table 1). There was moderate to good interobserver agreement for the overall zonal predominance (κ = 0.41–0.65) (Table 1).

The frequencies of the various CT findings are summarized in Table 1. All AEP patients presented with bilateral abnormal

Discussion

Previous studies have reported the general chest radiographic findings of AEP as bilateral diffuse infiltration with a non-segmental distribution [11], [12], [13], [14]. In the present study, bilateral areas with ground-glass attenuation were observed in all AEP patients on thin-section CT; this was the most common finding. Interlobular septal thickening was found in 26 (90%) of 29 patients and was the second most common finding. Furthermore, bilateral areas of air-space consolidation and

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Citation Excerpt :
A few patients may feel myalgia, night sweat, chills, chest pain, arthralgia and even abdominal pain [3–5]. CT shows bilateral patchy areas of ground-glass attenuation, frequently accompanied by consolidation opacities and smooth interlobular septal thickening and small to moderate-sized bilateral pleural effusions [4,6,7]. Eosinophils count increases in BALF and/or peripheral blood, and lung biopsy eosinophils infiltration can be found [2].
Acute eosinophilic pneumonia (AEP) is an acute febrile disease with good prognosis. It is often manifested as cough, dyspnea and fever, and sometimes may also as myalgia. However, there are no reports of AEP with sepsis-like symptoms of arthralgia, joint stiffness, lymph node enlargement, transient rashes and abnormal liver function in the literature.
A male patient with AEP was admitted to our hospital. He presented with fever, cough, arthralgia and joint stiffness, and also had transient rashes, lymph node enlargement and mild abnormal liver function. The counts of white blood cells and eosinophils were increased in peripheral blood. It seemed like sepsis, but his percutaneous lung biopsy suggested eosinophil inflammation, which had a good response to corticosteroids instead of antibiotics.
AEP is easily misdiagnosed as bacterial pneumonia with sepsis when it presents with lung infiltration on CT and atypical manifestations such as arthralgia, joint stiffness, lymph node enlargement, transient rashes and abnormal liver function. In this case, if a lot more antibiotics do not work, some of possible diseases including AEP may be considered. Increased eosinophils in peripheral blood and lung biopsy are helpful for the diagnosis of the disease.

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Acute eosinophilic pneumonia: Thin-section CT findings in 29 patients

Abstract

Purpose

Materials and methods

Results

Conclusion

Introduction

Section snippets

Study population

Results

Discussion

Chest

Clin Radiol

Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure

N Engl J Med

Eosinophilic lung diseases

Am J Respir Crit Care Med

Acute eosinophilic pneumonia in a heroin smoker

Eur Respir J

Acute eosinophilic pneumonia following intentional inhalation of Scotchguard

Ann Allergy

A case of acute eosinophilic pneumonia caused by inhalation of Trichosporon terrestre

Am J Respir Crit Care Med

Acute eosinophilic pneumonia associated with smoke from fireworks

Intern Med

Cigarette smoke-induced acute eosinophilic pneumonia

Radiology

Acute eosinophilic pneumonia following cigarette smoking

Intern Med