Eosinophilic Lung Diseases: A Clinical, Radiologic, and Pathologic Overview

Abstract

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.

Wheezing Beyond Bronchial Asthma

“…Regarding radiology, the most consistent radiological findings are lobular or centrilobular peripheral consolidation and nodularity, thickened bronchial walls, inter-lobular septum, and peri-cardial and pleural effusion. [17]On computed tomography, enlargement of or distortion of peripheral pulmonary arteries may be seen. The ultimate diagnosis is by biopsy with open biopsy preferred to TBLB( Transbronchial Lung Biopsy) or sural nerve sampling in case of symptoms.…”

Chronic Eosinophilic Pneumonia in a Breast Cancer Patient Post-Radiation Therapy: A Case Report

“…5 CEP is a disease of both females and males, with a preponderance in females. [4][5][6][7] It is extremely rare in children and has a peak incidence in adults of 50 years of age. 4,5 A third to a half of affected patients have a history of asthma, and ϳ90% of the cases either are nonsmokers or have a remote history of smoking, thus signifying a possible protective role for smoking.…”

“…4,5 A third to a half of affected patients have a history of asthma, and ϳ90% of the cases either are nonsmokers or have a remote history of smoking, thus signifying a possible protective role for smoking. 4,5,7 It is usually a diagnosis of exclusion, thus the need to exclude other causes of peripheral and lung eosinophilia. 4 Extrapulmonary manifestations are rare, and if present, the differential would include Churg-Strauss or hypereosinophilic syndrome.…”

Cough syncope and multiple pulmonary nodules

“…Inflammatory markers such as CRP and PCT levels may be negative, as is parasitological examination of the feces (since there is no fecal excretion of eggs in non-capable hosts such as humans). Chest radiographs and CT scans exhibit mild, patchy, unilateral or bilateral infiltrates associated with pulmonary nodules [2,5].…”

“…Churg and Strauss syndrome), and a wide group of eosinophilic lung diseases of unknown origin [2]. The diagnosis of visceral larva migrans due to Toxocara Canis must hinge upon a positive result of the ELISA test to TES-antigen exhibited by the migrating larvae.…”