Eosinophilic lung diseases are a diverse group of pulmonary disorders associated with peripheral or tissue eosinophilia. They are classified as eosinophilic lung diseases of unknown cause (simple pulmonary eosinophilia [SPE], acute eosinophilic pneumonia [AEP], chronic eosinophilic pneumonia [CEP], idiopathic hypereosinophilic syndrome [IHS]), eosinophilic lung diseases of known cause (allergic bronchopulmonary aspergillosis [ABPA], bronchocentric granulomatosis [BG], parasitic infections, drug reactions), and eosinophilic vasculitis (allergic angiitis, granulomatosis [Churg-Strauss syndrome]). The percentages of eosinophils in peripheral blood and bronchoalveolar lavage fluid are essential parts of the evaluation. Chest computed tomography (CT) demonstrates a more characteristic pattern and distribution of parenchymal opacities than does conventional chest radiography. At CT, SPE and IHS are characterized by single or multiple nodules with a surrounding ground-glass-opacity halo, AEP mimics radiologically hydrostatic pulmonary edema, and CEP is characterized by nonsegmental airspace consolidations with peripheral predominance. ABPA manifests with bilateral central bronchiectasis with or without mucoid impaction. The CT manifestations of BG are nonspecific and consist of a focal mass or lobar consolidation with atelectasis. The most common CT findings in Churg-Strauss syndrome include sub-pleural consolidation with lobular distribution, centrilobular nodules, bronchial wall thickening, and interlobular septal thickening. The integration of clinical, radiologic, and pathologic findings facilitates the initial and differential diagnoses of various eosinophilic lung diseases.
"Eosinophilia is also a characteristic of Wegener granulomatosis which is characterized by necrosis and granulomatous inflammation accompanied by a mixed cellular infiltrate . Another entity in the differential diagnosis is bronchocentric granulomatosis which is characterized by a necrotizing granulomatous inflammation of bronchiolar epithelium with chronic inflammatory changes in the surrounding parenchyma . Affected patients tend to have asthma, peripheral eosinophilia and positive sputum cultures for Aspergillus organism. "
[Show abstract][Hide abstract] ABSTRACT: Necrotizing sarcoid granulomatosis (NSG) is a rare disease which is classified in the spectrum of pulmonary angiitis and granulomatosis. It is a variant of sarcoidosis and differs from it histologically. Diagnosis is based on the pathological features, but radiology may help in the differential diagnosis. It is characterized by alveolar infiltrates or parenchymal nodules in multidetector computed tomography (MDCT). We report a case of a 50-year-old man with the diagnosis of NSG mimicking lung malignancy. Radiological and pathological findings and also the destructive course of the disease will be discussed.
"The alveolar form of lymphoma may present as primary lesion of the lung or as a part of disseminated disease. The persistent alveolar infiltrates have also been reported in cryptogenic organizing pneumonia and chronic eosinophilic pneumonia. Alveolar proteinosis usually present with typical radiological pattern of DAO. "
[Show abstract][Hide abstract] ABSTRACT: Diffuse alveolar opacities (DAO) due to pulmonary tuberculosis are usually described in immunocompromised patients. In adult patients residing in high endemic areas such as India, alveolar opacities are not reported frequently in non-immunocompromised pulmonary tuberculosis patients. We describe a twenty-five-year-old woman who presented with bilateral diffuse alveolar opacities and initial diagnostic work up was directed to non-tuberculosis etiologies. Her sputum was not suggestive of tuberculous or any other infective etiology. However, histopathological examination of specimen from fine needle aspiration cytology through percutaneous route suggested chronic granulomatous disease with detection of mycobacterium. Polymerase chain reaction test in BAL and FNAC specimen confirmed tubercular etiology. Though not frequent, pulmonary tuberculous etiology is worth considering in the differential diagnosis of DAO as not only tuberculosis is fully treatable but also early detection shall help to avoid unnecessary invasive tests and cut down transmission to contacts.
Lung India 10/2010; 27(4):236-8. DOI:10.4103/0970-2113.71959
"Eosinophilic lung diseases of unknown cause comprise Loeffler syndrome (characterized by migrating pulmonary opacities), acute eosinophilic pneumonia, and chronic eosinophilic pneumonia [174,175]. The idiopathic hyper-eosinophilic syndrome is a rare disorder observed mainly in adults; it is characterized by prolonged eosinophilia and a multiorgan system dysfunction due to eosinophil infiltration with pulmonary involvement documented in almost half of the patients [176,177]. "
[Show abstract][Hide abstract] ABSTRACT: Interstitial lung disease (ILD) in infants and children comprises a large spectrum of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. These disorders are characterized by inflammatory and fibrotic changes that affect alveolar walls. Typical features of ILD include dyspnea, diffuse infiltrates on chest radiographs, and abnormal pulmonary function tests with restrictive ventilatory defect and/or impaired gas exchange. Many pathological situations can impair gas exchange and, therefore, may contribute to progressive lung damage and ILD. Consequently, diagnosis approach needs to be structured with a clinical evaluation requiring a careful history paying attention to exposures and systemic diseases. Several classifications for ILD have been proposed but none is entirely satisfactory especially in children. The present article reviews current concepts of pathophysiological mechanisms, etiology and diagnostic approaches, as well as therapeutic strategies. The following diagnostic grouping is used to discuss the various causes of pediatric ILD: 1) exposure-related ILD; 2) systemic disease-associated ILD; 3) alveolar structure disorder-associated ILD; and 4) ILD specific to infancy. Therapeutic options include mainly anti-inflammatory, immunosuppressive, and/or anti-fibrotic drugs. The outcome is highly variable with a mortality rate around 15%. An overall favorable response to corticosteroid therapy is observed in around 50% of cases, often associated with sequelae such as limited exercise tolerance or the need for long-term oxygen therapy.
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