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Eosinophilic Lung Diseases: A Clinical, Radiologic, and Pathologic Overview¹

¹ From the Departments of Diagnostic Radiology (Y.J.J., K.-I.K., I.J.S.) and Pathology (C.H.L.), Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10, Ami-Dong, Seo-gu, Pusan 602-739, Korea; the Department of Radiology, Dong A University Hospital, Pusan, Korea (K.N.L., K.N.K.); the Department of Radiology, Dongguk University International Hospital, Gyeonggi-do, Korea (J.S.K.); and the Department of Radiology, Ulsan University Hospital, Ulsan, Korea (W.J.K.). Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received April 3, 2006; revision requested May 3; final revision received August 21; accepted August 22. All authors have no financial relationships to disclose.

View larger version (165K): [in this window] [in a new window] [Download PPT slide]   Figure 1.  High-power photomicrograph (original magnification, x1000; hematoxylin-eosin [H-E] stain) shows numerous eosinophils (arrows), each of which has a lobulated nucleus and cytoplasm that includes specific granules.

 

View larger version (53K): [in this window] [in a new window] [Download PPT slide]   Figure 2.  SPE in a 25-year-old man with 13.5% peripheral eosinophilia. Transverse thin-section (1-mm collimation) CT scan (lung windowing) shows consolidation and ground-glass opacity involving mainly the peripheral regions of both lower lobes. At follow-up radiography performed 10 days later, the parenchymal opacities had cleared spontaneously.

 

View larger version (120K): [in this window] [in a new window] [Download PPT slide]   Figure 3.  SPE in a 46-year-old woman with 30.1% peripheral eosinophilia. Transverse thin-section (1-mm collimation) CT scan (lung windowing) shows an airspace nodule with surrounding ground-glass opacity in the right lower lobe (arrow). At follow-up chest radiography, the nodule had disappeared.

 

View larger version (165K): [in this window] [in a new window] [Download PPT slide]   Figure 4a.  AEP in a 29-year-old man with 26% BAL fluid eosinophilia. (a) Chest radiograph obtained 7 days after the onset of dyspnea reveals reticular densities with patchy consolidation and ground-glass opacities in both lungs. (b) Thin-section (1-mm collimation) CT scan (lung windowing) shows multifocal patchy areas of ground-glass opacity and consolidation with smooth interlobular septal thickening (arrows) in both lower lobes. Bilateral pleural effusions are also seen. (c) High-power photomicrograph (original magnification, x400; H-E stain) of a transbronchial lung biopsy specimen obtained from the left lower lobe 5 days after a shows the infiltration of eosinophils (arrows) and lymphocytes into the alveolar spaces and alveolar walls. Note the absence of interstitial fibrosis.

 

View larger version (85K): [in this window] [in a new window] [Download PPT slide]   Figure 4b.  AEP in a 29-year-old man with 26% BAL fluid eosinophilia. (a) Chest radiograph obtained 7 days after the onset of dyspnea reveals reticular densities with patchy consolidation and ground-glass opacities in both lungs. (b) Thin-section (1-mm collimation) CT scan (lung windowing) shows multifocal patchy areas of ground-glass opacity and consolidation with smooth interlobular septal thickening (arrows) in both lower lobes. Bilateral pleural effusions are also seen. (c) High-power photomicrograph (original magnification, x400; H-E stain) of a transbronchial lung biopsy specimen obtained from the left lower lobe 5 days after a shows the infiltration of eosino-phils (arrows) and lymphocytes into the alveolar spaces and alveolar walls. Note the absence of interstitial fibrosis.

 

View larger version (171K): [in this window] [in a new window] [Download PPT slide]   Figure 4c.  AEP in a 29-year-old man with 26% BAL fluid eosinophilia. (a) Chest radiograph obtained 7 days after the onset of dyspnea reveals reticular densities with patchy consolidation and ground-glass opacities in both lungs. (b) Thin-section (1-mm collimation) CT scan (lung windowing) shows multifocal patchy areas of ground-glass opacity and consolidation with smooth interlobular septal thickening (arrows) in both lower lobes. Bilateral pleural effusions are also seen. (c) High-power photomicrograph (original magnification, x400; H-E stain) of a transbronchial lung biopsy specimen obtained from the left lower lobe 5 days after a shows the infiltration of eosinophils (arrows) and lymphocytes into the alveolar spaces and alveolar walls. Note the absence of interstitial fibrosis.

 

View larger version (104K): [in this window] [in a new window] [Download PPT slide]   Figure 5.  AEP in an 18-year-old woman with acute onset of fever and dyspnea. The patient had 27% BAL fluid eosinophilia. Thin-section (1-mm collimation) CT scan (lung windowing) shows areas of ground-glass opacity and interlobular septal thickening in both lungs. Bilateral pleural effusions are also seen.

 

View larger version (124K): [in this window] [in a new window] [Download PPT slide]   Figure 6a.  CEP in a 59-year-old man with a 3-week history of severe cough and fever. The patient had 25% BAL fluid eosinophilia. (a) Thin-section (1-mm collimation) CT scan (lung windowing) shows ground-glass opacities with intralobular interstitial thickening in both lower lobes. (b) High-power photomicrograph (original magnification, x400; H-E stain) of a transbronchial lung biopsy specimen shows infiltration of eosinophils and polymorphous inflammatory cells into the alveolar lumen and interstitium and a varying degree of interstitial fibrosis (arrows).

 

View larger version (146K): [in this window] [in a new window] [Download PPT slide]   Figure 6b.  CEP in a 59-year-old man with a 3-week history of severe cough and fever. The patient had 25% BAL fluid eosinophilia. (a) Thin-section (1-mm collimation) CT scan (lung windowing) shows ground-glass opacities with intralobular interstitial thickening in both lower lobes. (b) High-power photomicrograph (original magnification, x400; H-E stain) of a transbronchial lung biopsy specimen shows infiltration of eosinophils and polymorphous inflammatory cells into the alveolar lumen and interstitium and a varying degree of interstitial fibrosis (arrows).

 

View larger version (107K): [in this window] [in a new window] [Download PPT slide]   Figure 7a.  CEP in a 29-year-old man with 27.5% peripheral and 30% BAL fluid eosinophilia. (a) Chest radiograph shows airspace consolidation confined mainly to the peripheral lung (photographic negative shadow of pulmonary edema). (b) Transverse thin-section (1-mm collimation) CT scan (lung windowing) also shows airspace consolidation primarily involving the peripheral lung.

 

View larger version (78K): [in this window] [in a new window] [Download PPT slide]   Figure 7b.  CEP in a 29-year-old man with 27.5% peripheral and 30% BAL fluid eosinophilia. (a) Chest radiograph shows airspace consolidation confined mainly to the peripheral lung (photographic negative shadow of pulmonary edema). (b) Transverse thin-section (1-mm collimation) CT scan (lung windowing) also shows airspace consolidation primarily involving the peripheral lung.

 

View larger version (117K): [in this window] [in a new window] [Download PPT slide]   Figure 8a.  IHS in a 3-month-old boy with erythematous rash over his entire body. The patient had persistent eosinophilia of 1600 cells per cubic millimeter for 12 months. (a) Initial chest radiograph shows bilateral diffuse ground-glass opacities. (b) High-resolution CT scan obtained the same day shows diffuse ground-glass opacities in both lungs. (c) High-power photomicrograph (original magnification, x400; H-E stain) of an open biopsy specimen obtained from the right lower lobe 1 month after b reveals infiltration of eosinophils into the alveoli and interstitium. Note the formation of indistinct granuloma (arrow). (d) High-power photomicrograph (original magnification, x400; H-E stain) of a percutaneous liver biopsy specimen obtained 1 month after b reveals eosinophil infiltration into the sinusoids. Bone marrow biopsy revealed normocellular marrow consisting of 18% eosinophils and no blast cells. (e, f) CT scans (5-mm collimation, lung windowing) obtained 5 months after b show multiple nodules in the left upper lobe (arrows).

 

View larger version (90K): [in this window] [in a new window] [Download PPT slide]   Figure 8b.  IHS in a 3-month-old boy with erythematous rash over his entire body. The patient had persistent eosinophilia of 1600 cells per cubic millimeter for 12 months. (a) Initial chest radiograph shows bilateral diffuse ground-glass opacities. (b) High-resolution CT scan obtained the same day shows diffuse ground-glass opacities in both lungs. (c) High-power photomicrograph (original magnification, x400; H-E stain) of an open biopsy specimen obtained from the right lower lobe 1 month after b reveals infiltration of eosinophils into the alveoli and interstitium. Note the formation of indistinct granuloma (arrow). (d) High-power photomicrograph (original magnification, x400; H-E stain) of a percutaneous liver biopsy specimen obtained 1 month after b reveals eosinophil infiltration into the sinusoids. Bone marrow biopsy revealed normocellular marrow consisting of 18% eosinophils and no blast cells. (e, f) CT scans (5-mm collimation, lung windowing) obtained 5 months after b show multiple nodules in the left upper lobe (arrows).

 

View larger version (174K): [in this window] [in a new window] [Download PPT slide]   Figure 8c.  IHS in a 3-month-old boy with erythematous rash over his entire body. The patient had persistent eosinophilia of 1600 cells per cubic millimeter for 12 months. (a) Initial chest radiograph shows bilateral diffuse ground-glass opacities. (b) High-resolution CT scan obtained the same day shows diffuse ground-glass opacities in both lungs. (c) High-power photomicrograph (original magnification, x400; H-E stain) of an open biopsy specimen obtained from the right lower lobe 1 month after b reveals infiltration of eosinophils into the alveoli and interstitium. Note the formation of indistinct granuloma (arrow). (d) High-power photomicrograph (original magnification, x400; H-E stain) of a percutaneous liver biopsy specimen obtained 1 month after b reveals eosinophil infiltration into the sinusoids. Bone marrow biopsy revealed normocellular marrow consisting of 18% eosinophils and no blast cells. (e, f) CT scans (5-mm collimation, lung windowing) obtained 5 months after b show multiple nodules in the left upper lobe (arrows).

 

View larger version (174K): [in this window] [in a new window] [Download PPT slide]   Figure 8d.  IHS in a 3-month-old boy with erythematous rash over his entire body. The patient had persistent eosinophilia of 1600 cells per cubic millimeter for 12 months. (a) Initial chest radiograph shows bilateral diffuse ground-glass opacities. (b) High-resolution CT scan obtained the same day shows diffuse ground-glass opacities in both lungs. (c) High-power photomicrograph (original magnification, x400; H-E stain) of an open biopsy specimen obtained from the right lower lobe 1 month after b reveals infiltration of eosinophils into the alveoli and interstitium. Note the formation of indistinct granuloma (arrow). (d) High-power photomicrograph (original magnification, x400; H-E stain) of a percutaneous liver biopsy specimen obtained 1 month after b reveals eosinophil infiltration into the sinusoids. Bone marrow biopsy revealed normocellular marrow consisting of 18% eosinophils and no blast cells. (e, f) CT scans (5-mm collimation, lung windowing) obtained 5 months after b show multiple nodules in the left upper lobe (arrows).

 

View larger version (80K): [in this window] [in a new window] [Download PPT slide]   Figure 8e.  IHS in a 3-month-old boy with erythematous rash over his entire body. The patient had persistent eosin-ophilia of 1600 cells per cubic millimeter for 12 months. (a) Initial chest radiograph shows bilateral diffuse ground-glass opacities. (b) High-resolution CT scan obtained the same day shows diffuse ground-glass opacities in both lungs. (c) High-power photomicrograph (original magnification, x400; H-E stain) of an open biopsy specimen obtained from the right lower lobe 1 month after b reveals infiltration of eosinophils into the alveoli and interstitium. Note the formation of indistinct granuloma (arrow). (d) High-power photomicrograph (original magnification, x400; H-E stain) of a percutaneous liver biopsy specimen obtained 1 month after b reveals eosinophil infiltration into the sinusoids. Bone marrow biopsy revealed normocellular marrow consisting of 18% eosinophils and no blast cells. (e, f) CT scans (5-mm collimation, lung windowing) obtained 5 months after b show multiple nodules in the left upper lobe (arrows).

 

View larger version (60K): [in this window] [in a new window] [Download PPT slide]   Figure 8f.  IHS in a 3-month-old boy with erythematous rash over his entire body. The patient had persistent eosinophilia of 1600 cells per cubic millimeter for 12 months. (a) Initial chest radiograph shows bilateral diffuse ground-glass opacities. (b) High-resolution CT scan obtained the same day shows diffuse ground-glass opacities in both lungs. (c) High-power photomicrograph (original magnification, x400; H-E stain) of an open biopsy specimen obtained from the right lower lobe 1 month after b reveals infiltration of eosinophils into the alveoli and interstitium. Note the formation of indistinct granuloma (arrow). (d) High-power photomicrograph (original magnification, x400; H-E stain) of a percutaneous liver biopsy specimen obtained 1 month after b reveals eosinophil infiltration into the sinusoids. Bone marrow biopsy revealed normocellular marrow consisting of 18% eosinophils and no blast cells. (e, f) CT scans (5-mm collimation, lung windowing) obtained 5 months after b show multiple nodules in the left upper lobe (arrows).

 

View larger version (96K): [in this window] [in a new window] [Download PPT slide]   Figure 9a.  IHS in a 45-year-old man with persistent eosinophilia of 1800–3200 cells per cubic millimeter for more than 6 months. The patient had 52% BAL fluid eosinophilia. Transverse thin-section (1-mm collimation) CT scans (lung windowing) obtained at two levels reveal large nodules with surrounding ground-glass opacity in the left lung (arrow).

 

View larger version (129K): [in this window] [in a new window] [Download PPT slide]   Figure 9b.  IHS in a 45-year-old man with persistent eosinophilia of 1800–3200 cells per cubic millimeter for more than 6 months. The patient had 52% BAL fluid eosinophilia. Transverse thin-section (1-mm collimation) CT scans (lung windowing) obtained at two levels reveal large nodules with surrounding ground-glass opacity in the left lung (arrow).

 

View larger version (132K): [in this window] [in a new window] [Download PPT slide]   Figure 10a.  ABPA in a 31-year-old asthmatic man with 15% peripheral eosinophilia. (a) Chest radiograph shows tubular and cystic lesions in the central portions of both lungs. Note also the mucus plugging with a gloved-finger appearance (arrows). (b) Thin-section (1-mm collimation) CT scan (lung windowing) demonstrates central bronchiectasis with mucus plugging (arrows), centrilobular nodules, and bronchial wall thickening involving predominantly the segmental and subsegmental bronchi of the upper lobes. (c) Photomicrograph (original magnification, x100; H-E stain) of the impacted mucoid material from a bronchoscopic biopsy specimen reveals parallel rows of necrotic eosinophils and cellular debris within a mucinous background. (d) High-power photomicrograph (original magnification, x400; Gomori methenamine silver stain) shows branching fungal hyphae within impacted mucus, a finding that is suggestive of Aspergillus species.

 

View larger version (110K): [in this window] [in a new window] [Download PPT slide]   Figure 10b.  ABPA in a 31-year-old asthmatic man with 15% peripheral eosinophilia. (a) Chest radiograph shows tubular and cystic lesions in the central portions of both lungs. Note also the mucus plugging with a gloved-finger appearance (arrows). (b) Thin-section (1-mm collimation) CT scan (lung windowing) demonstrates central bronchiectasis with mucus plugging (arrows), centrilobular nodules, and bronchial wall thickening involving predominantly the segmental and subsegmental bronchi of the upper lobes. (c) Photomicrograph (original magnification, x100; H-E stain) of the impacted mucoid material from a bronchoscopic biopsy specimen reveals parallel rows of necrotic eosinophils and cellular debris within a mucinous background. (d) High-power photomicrograph (original magnification, x400; Gomori methenamine silver stain) shows branching fungal hyphae within impacted mucus, a finding that is suggestive of Aspergillus species.

 

View larger version (166K): [in this window] [in a new window] [Download PPT slide]   Figure 10c.  ABPA in a 31-year-old asthmatic man with 15% peripheral eosinophilia. (a) Chest radiograph shows tubular and cystic lesions in the central portions of both lungs. Note also the mucus plugging with a gloved-finger appearance (arrows). (b) Thin-section (1-mm collimation) CT scan (lung windowing) demonstrates central bronchiectasis with mucus plugging (arrows), centrilobular nodules, and bronchial wall thickening involving predominantly the segmental and subsegmental bronchi of the upper lobes. (c) Photomicrograph (original magnification, x100; H-E stain) of the impacted mucoid material from a bronchoscopic biopsy specimen reveals parallel rows of necrotic eosinophils and cellular debris within a mucinous background. (d) High-power photomicrograph (original magnification, x400; Gomori methenamine silver stain) shows branching fungal hyphae within impacted mucus, a finding that is suggestive of Aspergillus species.

 

View larger version (69K): [in this window] [in a new window] [Download PPT slide]   Figure 10d.  ABPA in a 31-year-old asthmatic man with 15% peripheral eosinophilia. (a) Chest radiograph shows tubular and cystic lesions in the central portions of both lungs. Note also the mucus plugging with a gloved-finger appearance (arrows). (b) Thin-section (1-mm collimation) CT scan (lung windowing) demonstrates central bronchiectasis with mucus plugging (arrows), centrilobular nodules, and bronchial wall thickening involving predominantly the segmental and subsegmental bronchi of the upper lobes. (c) Photomicrograph (original magnification, x100; H-E stain) of the impacted mucoid material from a bronchoscopic biopsy specimen reveals parallel rows of necrotic eosinophils and cellular debris within a mucinous background. (d) High-power photomicrograph (original magnification, x400; Gomori methenamine silver stain) shows branching fungal hyphae within impacted mucus, a finding that is suggestive of Aspergillus species.

 

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 11a.  BG in a 25-year-old asthmatic man with 13% peripheral eosinophilia. (a) Chest radiograph shows consolidation and nodular opacities in the left upper lobe. (b) Transverse thin-section (2.5-mm collimation) CT scan (mediastinal windowing) obtained at the level of the left atrium shows a lobulated soft-tissue mass (arrow) with obstruction of the lingular segmental bronchus. (c) High-power photomicrograph (original magnification, x400; H-E stain) of a bronchoscopic biopsy specimen shows eosinophilic cellular debris and Charcot-Leyden crystals (arrowhead). (d) Photomicrograph (original magnification, x40; H-E stain) of the surgical specimen reveals bronchocentric granuloma formation (arrows) with focal necrosis.

 

View larger version (104K): [in this window] [in a new window] [Download PPT slide]   Figure 11b.  BG in a 25-year-old asthmatic man with 13% peripheral eosinophilia. (a) Chest radiograph shows consolidation and nodular opacities in the left upper lobe. (b) Transverse thin-section (2.5-mm collimation) CT scan (mediastinal windowing) obtained at the level of the left atrium shows a lobulated soft-tissue mass (arrow) with obstruction of the lingular segmental bronchus. (c) High-power photomicrograph (original magnification, x400; H-E stain) of a bronchoscopic biopsy specimen shows eosinophilic cellular debris and Charcot-Leyden crystals (arrowhead). (d) Photomicrograph (original magnification, x40; H-E stain) of the surgical specimen reveals bronchocentric granuloma formation (arrows) with focal necrosis.

 

View larger version (150K): [in this window] [in a new window] [Download PPT slide]   Figure 11c.  BG in a 25-year-old asthmatic man with 13% peripheral eosinophilia. (a) Chest radiograph shows consolidation and nodular opacities in the left upper lobe. (b) Transverse thin-section (2.5-mm collimation) CT scan (mediastinal windowing) obtained at the level of the left atrium shows a lobulated soft-tissue mass (arrow) with obstruction of the lingular segmental bronchus. (c) High-power photomicrograph (original magnification, x400; H-E stain) of a bronchoscopic biopsy specimen shows eosinophilic cellular debris and Charcot-Leyden crystals (arrowhead). (d) Photomicrograph (original magnification, x40; H-E stain) of the surgical specimen reveals bronchocentric granuloma formation (arrows) with focal necrosis.

 

View larger version (141K): [in this window] [in a new window] [Download PPT slide]   Figure 11d.  BG in a 25-year-old asthmatic man with 13% peripheral eosinophilia. (a) Chest radiograph shows consolidation and nodular opacities in the left upper lobe. (b) Transverse thin-section (2.5-mm collimation) CT scan (mediastinal windowing) obtained at the level of the left atrium shows a lobulated soft-tissue mass (arrow) with obstruction of the lingular segmental bronchus. (c) High-power photomicrograph (original magnification, x400; H-E stain) of a bronchoscopic biopsy specimen shows eosinophilic cellular debris and Charcot-Leyden crystals (arrowhead). (d) Photomicrograph (original magnification, x40; H-E stain) of the surgical specimen reveals bronchocentric granuloma formation (arrows) with focal necrosis.

 

View larger version (65K): [in this window] [in a new window] [Download PPT slide]   Figure 12.  Maps illustrate the geographic distributions of common parasites. Strongyloides and Wuchereria infections are found in tropical and subtropical areas. The main endemic areas of paragonimiasis are East Asia, Southeast Asia, Latin America, and Africa. Clonorchiasis is endemic to Asia, including Korea, China, Taiwan, and Vietnam. Ancylostoma and Schistosoma infections are frequently seen in Africa, South America, and Asia. Dirofilariasis has been reported predominantly in the temperate climate of the East Coast and South in the United States. Entamoeba and Toxocara infections are distributed worldwide.

 

View larger version (115K): [in this window] [in a new window] [Download PPT slide]   Figure 13.  C sinensis infestation in a 25-year-old man. A skin test for C sinensis was strongly positive, and Clonorchis-specific IgG antibody by enzyme-linked im-munosorbent assay was 0.27 (normal range, 0–0.25). Transverse thin-section (1-mm collimation) CT scan (lung windowing) shows multiple airspace nodules with surrounding ground-glass opacity in both lungs (arrows).

 

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 14a.  PP in a 47-year-old man. (a) Chest radiograph shows several linear densities in both lungs as well as right-sided pleural effusion. (b) Transverse thin-section (1-mm collimation) CT scan (lung windowing) demonstrates subpleural linear opacities and tubular structures (arrows), both of which findings suggest worm migration tracts.

 

View larger version (68K): [in this window] [in a new window] [Download PPT slide]   Figure 14b.  PP in a 47-year-old man. (a) Chest radiograph shows several linear densities in both lungs as well as right-sided pleural effusion. (b) Transverse thin-section (1-mm collimation) CT scan (lung windowing) demonstrates subpleural linear opacities and tubular structures (arrows), both of which findings suggest worm migration tracts.

 

View larger version (86K): [in this window] [in a new window] [Download PPT slide]   Figure 15.  PP in a 42-year-old woman with 70% peripheral eosinophilia. A skin test for P westermani was positive. Transverse thin-section (1-mm collimation) CT scan (lung windowing) shows multiple nodules and thin-walled cysts (arrows) in the right middle and lower lobes. Note the linear opacity in the left lower lobe (arrowhead).

 

View larger version (101K): [in this window] [in a new window] [Download PPT slide]   Figure 16a.  PP in a 46-year-old man with blood-tinged sputum and a history of ingestion of raw freshwater fish. (a–c) Chest CT scans (lung windowing in a, mediastinal windowing in b and c) show a low-opacity mass with a spiculated margin in the peripheral portion of the right upper lobe. Focal pleural thickening is also noted (arrow in b and c). (d) Photomicrograph (original magnification, x200; H-E stain) of lung tissue obtained at open biopsy of the right upper lobe reveals eggs of P westermani (arrows) with associated necrotizing granulomatous inflammation and eosinophilic infiltrates.

 

View larger version (101K): [in this window] [in a new window] [Download PPT slide]   Figure 16b.  PP in a 46-year-old man with blood-tinged sputum and a history of ingestion of raw freshwater fish. (a–c) Chest CT scans (lung windowing in a, mediastinal windowing in b and c) show a low-opacity mass with a spiculated margin in the peripheral portion of the right upper lobe. Focal pleural thickening is also noted (arrow in b and c). (d) Photomicrograph (original magnification, x200; H-E stain) of lung tissue obtained at open biopsy of the right upper lobe reveals eggs of P westermani (arrows) with associated necrotizing granulomatous inflammation and eosinophilic infiltrates.

 

View larger version (104K): [in this window] [in a new window] [Download PPT slide]   Figure 16c.  PP in a 46-year-old man with blood-tinged sputum and a history of ingestion of raw freshwater fish. (a–c) Chest CT scans (lung windowing in a, mediastinal windowing in b and c) show a low-opacity mass with a spiculated margin in the peripheral portion of the right upper lobe. Focal pleural thickening is also noted (arrow in b and c). (d) Photomicrograph (original magnification, x200; H-E stain) of lung tissue obtained at open biopsy of the right upper lobe reveals eggs of P westermani (arrows) with associated necrotizing granulomatous inflammation and eosinophilic infiltrates.

 

View larger version (176K): [in this window] [in a new window] [Download PPT slide]   Figure 16d.  PP in a 46-year-old man with blood-tinged sputum and a history of ingestion of raw freshwater fish. (a–c) Chest CT scans (lung windowing in a, mediastinal windowing in b and c) show a low-opacity mass with a spiculated margin in the peripheral portion of the right upper lobe. Focal pleural thickening is also noted (arrow in b and c). (d) Photomicrograph (original magnification, x200; H-E stain) of lung tissue obtained at open biopsy of the right upper lobe reveals eggs of P westermani (arrows) with associated necrotizing granulomatous inflammation and eosinophilic infiltrates.

 

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 17.  PP in a 44-year-old man. FDG PET scan demonstrates high glucose uptake (standardized uptake value = 5.6), a finding that suggests malignancy. Percutaneous aspiration biopsy revealed eosinophilic organizing pneumonia containing multiple eggs of P westermani.

 

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 18.  Pleural and pericardial paragonimiasis in a 31-year-old man with 20% peripheral eosinophilia. Contrast material– enhanced chest CT scan (mediastinal windowing) demonstrates pericardial and left pleural effusion with homogeneous thickening and enhancement of the pericardium and pleura. Eggs of P westermani were found in the pleural fluid.

 

View larger version (142K): [in this window] [in a new window] [Download PPT slide]   Figure 19a.  DRESS syndrome caused by the antituberculous medication rifampin in a 30-year-old woman. The patient had 20% BAL fluid eosinophilia. (a) Transverse thin-section CT scan (lung windowing) shows consolidation with volume loss in the left lower lobe. (b) High-power photomicrograph (original magnification, x400; H-E stain) of a muscle biopsy specimen reveals infiltrates composed of eosinophils, lymphocytes, and plasma cells within the muscle fiber. Similar findings were seen in the periportal area, alveolar septa and adjacent interstitium, and dermis at microscopic analysis of biopsy specimens obtained from the liver, lung, and skin, respectively.

 

View larger version (142K): [in this window] [in a new window] [Download PPT slide]   Figure 19b.  DRESS syndrome caused by the antituberculous medication rifampin in a 30-year-old woman. The patient had 20% BAL fluid eosinophilia. (a) Transverse thin-section CT scan (lung windowing) shows consolidation with volume loss in the left lower lobe. (b) High-power photomicrograph (original magnification, x400; H-E stain) of a muscle biopsy specimen reveals infiltrates composed of eosinophils, lymphocytes, and plasma cells within the muscle fiber. Similar findings were seen in the periportal area, alveolar septa and adjacent interstitium, and dermis at microscopic analysis of biopsy specimens obtained from the liver, lung, and skin, respectively.

 

View larger version (118K): [in this window] [in a new window] [Download PPT slide]   Figure 20.  Ampicillin-induced pneumonia in a 69-year-old man with 24.1% peripheral eosinophilia. Transverse thin-section (1-mm collimation) CT scan (lung windowing) demonstrates multifocal patchy areas of ground-glass opacity with thickening of the interlobular and intralobular interstitium.

 

View larger version (78K): [in this window] [in a new window] [Download PPT slide]   Figure 21a.  Churg-Strauss syndrome in a 30-year-old asthmatic man who presented with chronic cough, dyspnea, and skin rash. The patient had 17% peripheral and 32% BAL fluid eosinophilia. (a) Thin-section (1-mm collimation) CT scan (lung windowing) demonstrates multiple small centrilobular nodules, bronchial wall thickening, and ground-glass opacity in both lung bases. (b) Photomicrograph (original magnification, x200; H-E stain) of an open biopsy specimen obtained from the right lower lobe 3 months after a shows eosinophilic organizing pneumonia.

 

View larger version (161K): [in this window] [in a new window] [Download PPT slide]   Figure 21b.  Churg-Strauss syndrome in a 30-year-old asthmatic man who presented with chronic cough, dyspnea, and skin rash. The patient had 17% peripheral and 32% BAL fluid eosinophilia. (a) Thin-section (1-mm collimation) CT scan (lung windowing) demonstrates multiple small centrilobular nodules, bronchial wall thickening, and ground-glass opacity in both lung bases. (b) Photomicrograph (original magnification, x200; H-E stain) of an open biopsy specimen obtained from the right lower lobe 3 months after a shows eosinophilic organizing pneumonia.

 

View larger version (62K): [in this window] [in a new window] [Download PPT slide]   Figure 22a.  Churg-Strauss syndrome in a 49-year-old asthmatic woman with quadriparesis and skin rash. The patient had a leukocyte count of 15,640 leukocytes per microliter and 49% peripheral eosinophilia. (a) Thin-section CT scan (lung windowing) shows subpleural ground-glass opacity, focal lobular consolidation, centrilobular nodules, and bronchial wall thickening in both lung bases. (b) High-power photomicrograph (original magnification, x400; H-E stain) of a biopsy specimen obtained from the skin of the leg reveals necrotizing vasculitis (arrows) involving small dermal vessels. Peripheral nerve biopsy revealed eosinophilic vasculitis.

 

View larger version (141K): [in this window] [in a new window] [Download PPT slide]   Figure 22b.  Churg-Strauss syndrome in a 49-year-old asthmatic woman with quadriparesis and skin rash. The patient had a leukocyte count of 15,640 leukocytes per microliter and 49% peripheral eosinophilia. (a) Thin-section CT scan (lung windowing) shows subpleural ground-glass opacity, focal lobular consolidation, centrilobular nodules, and bronchial wall thickening in both lung bases. (b) High-power photomicrograph (original magnification, x400; H-E stain) of a biopsy specimen obtained from the skin of the leg reveals necrotizing vasculitis (arrows) involving small dermal vessels. Peripheral nerve biopsy revealed eosinophilic vasculitis.

 

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