RSNA Education Exhibits

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

Published Online:May 1 2007https://doi.org/10.1148/rg.273065051

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.

References

1 AllenJN, Davis WB. Eosinophilic lung diseases. Am J Respir Crit Care Med1994; 150: 1423–1438. Crossref, Medline, Google Scholar
2 AllenJN, Davis WB, Pacht ER. Diagnostic significance of increased bronchoalveolar lavage fluid eosinophils. Am Rev Respir Dis1990; 142: 642–647. Crossref, Medline, Google Scholar
3 DavisWB, Fells GA, Sun XH, Gadek JE, Venet A, Crystal RG. Eosinophil-mediated injury to lung parenchymal cells and interstitial matrix: a possible role for eosinophils in chronic inflammatory disorders of the lower respiratory tract. J Clin Invest1984; 74: 269–278. Crossref, Medline, Google Scholar
4 FriedmanPJ, Liebow AA, Sokoloff J. Eosinophil granuloma of lung: clinical aspects of primary histiocytosis in the adult. Medicine1981; 60: 385–396. Crossref, Medline, Google Scholar
5 LombardCM, Tazelaar HD, Krasne DL. Pulmonary eosinophilia in coccidioidal infections. Chest1987; 91: 734–736. Crossref, Medline, Google Scholar
6 Fleury-FeithJ, Van Nhieu JT, Picard C, Escudier E, Bernaudin JF. Bronchoalveolar lavage eosinophilia associated with Pneumocystis carinii pneumonitis in AIDS patients: comparative study with non-AIDS patients. Chest1989; 95: 1198–1201. Crossref, Medline, Google Scholar
7 WellerPF. The immunobiology of eosinophils. N Engl J Med1991; 324: 1110–1118. Crossref, Medline, Google Scholar
8 TakayanagiN, Kanazawa M, Kawabata Y, Colby TV. Chronic bronchiolitis with associated eosinophilic lung disease (eosinophilic bronchiolitis). Respiration2001; 68: 319–322. Crossref, Medline, Google Scholar
9 JohkohT, Muller NL, Akira M, et al. Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients. Radiology2000; 216: 773–780. Link, Google Scholar
10 FordRM. Transient pulmonary eosinophilia and asthma: a review of 20 cases occurring in 5,702 asthma sufferers. Am Rev Respir Dis1966; 93: 797–803. Medline, Google Scholar
11 CordierJF. Eosinophilic pneumonias. In: Schwarz M, King T, eds. Interstitial lung disease. 4th ed. Toronto, Canada: Decker, 2003; 657–700. Google Scholar
12 BainGA, Flower CD. Pulmonary eosinophilia. Eur J Radiol1996; 23: 3–8. Crossref, Medline, Google Scholar
13 KimY, Lee KS, Choi DC, Primack SL, Im JG. The spectrum of eosinophilic lung disease: radiologic findings. J Comput Assist Tomogr1997; 21: 920–930. Crossref, Medline, Google Scholar
14 KimY, Lee KS, Jung KJ, Han J, Kim JS, Suh JS. Halo sign on high resolution CT: findings in spectrum of pulmonary diseases with pathologic correlation. J Comput Assist Tomogr1999; 23(4): 622–626. Crossref, Medline, Google Scholar
15 AllenJN, Pacht ER, Gadek JE, Davis WB. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med1989; 321: 569–574. Crossref, Medline, Google Scholar
16 OgawaH, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S. Transient wheeze: eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia. Chest1993; 104: 493–496. Crossref, Medline, Google Scholar
17 PhilitF, Etienne-Mastroianni B, Parrot A, Guerin C, Robert D, Cordier JF. Idiopathic acute eosinophilic pneumonia: a study of 22 patients. Am J Respir Crit Care Med2002; 166(9): 1235–1239. Crossref, Medline, Google Scholar
18 NakajimaM, Manabe T, Niki Y, Matsushima T. Cigarette smoke–induced acute eosinophilic pneumonia. Radiology1998; 207: 829–831. Medline, Google Scholar
19 ShintaniH, Fujimura M, Yasui M, et al. Acute eosinophilic pneumonia caused by cigarette smoking. Intern Med2000; 39: 66–68. Crossref, Medline, Google Scholar
20 RomWN, Weiden M, Garcia R, et al. Acute eosinophilic pneumonia in a New York City fire-fighter exposed to World Trade Center dust. Am J Respir Crit Care Med2002; 166(6): 797–800. Crossref, Medline, Google Scholar
21 HiraiK, Yamazaki Y, Okada K, Furuta S, Kubo K. Acute eosinophilic pneumonia associated with smoke from fireworks. Intern Med2000; 39: 401–403. Crossref, Medline, Google Scholar
22 TazelaarHD, Linz LJ, Colby TV, Myers JL, Limper AH. Acute eosinophilic pneumonia: histopathologic findings in nine patients. Am J Respir Crit Care Med1997; 155: 296–302. Crossref, Medline, Google Scholar
23 CheonJE, Lee KS, Jung GS, Chung MH, Cho YD. Acute eosinophilic pneumonia: radiographic and CT findings in six patients. AJR Am J Roentgenol1996; 167: 1195–1199. Crossref, Medline, Google Scholar
24 KingMA, Pope-Harman AL, Allen JN, Christoforidis GA, Christoforidis AJ. Acute eosinophilic pneumonia: radiologic and clinical features. Radiology1997; 203: 715–719. Link, Google Scholar
25 CarringtonCB, Addington WW, Goff AM, et al. Chronic eosinophilic pneumonia. N Engl J Med1969; 280: 787–798. Crossref, Medline, Google Scholar
26 JederlinicPJ, Sicilian L, Gaensler EA. Chronic eosinophilic pneumonia: a report of 19 cases and a review of the literature. Medicine1988; 67: 154–162. Crossref, Medline, Google Scholar
27 FoxB, Seed WA. Chronic eosinophilic pneumonia. Thorax1980; 35: 570–580. Crossref, Medline, Google Scholar
28 NaughtonM, Fahy J, FitzGerald MX. Chronic eosinophilic pneumonia: a long-term follow-up of 12 patients. Chest1993; 103: 162–165. Crossref, Medline, Google Scholar
29 BrezisM, Lafair J. Thrombocytosis in chronic eosinophilic pneumonia. Chest1979; 76: 231–232. Crossref, Medline, Google Scholar
30 DejaegherP, Demedts M. Bronchoalveolar lavage in eosinophilic pneumonia before and during corticosteroid therapy. Am Rev Respir Dis1984; 129: 631–632. Medline, Google Scholar
31 MochimaruH, Kawamoto M, Fukuda Y, Kudoh S. Clinicopathological differences between acute and chronic eosinophilic pneumonia. Respirology2005; 10: 76–85. Crossref, Medline, Google Scholar
32 GaenslerEA, Carrington CB. Peripheral opacities in chronic eosinophilic pneumonia: the photographic negative of pulmonary edema. AJR Am J Roentgenol1977; 128: 1–13. Crossref, Medline, Google Scholar
33 EbaraH, Ikezoe J, Johkoh T, et al. Chronic eosinophilic pneumonia: evolution of chest radiograms and CT features. J Comput Assist Tomogr1994; 18: 737–744. Crossref, Medline, Google Scholar
34 McCarthyDS, Pepys J. Cryptogenic pulmonary eosinophilias. Clin Allergy1973; 3: 339–351. Crossref, Medline, Google Scholar
35 MayoJR, Muller NL, Road J, Sisler J, Lillington G. Chronic eosinophilic pneumonia: CT findings in six cases. AJR Am J Roentgenol1989; 153: 727–730. Crossref, Medline, Google Scholar
36 SammanYS, Wali SO, Abdelaal MA, Gangi MT, Krayem AB. Chronic eosinophilic pneumonia presenting with recurrent massive bilateral pleural effusion. Chest2001; 119: 968–970. Crossref, Medline, Google Scholar
37 ChoiYH, Im JG, Han BK, Kim JH, Lee KY, Myoung NH. Thoracic manifestation of Churg-Strauss syndrome: radiologic and clinical findings. Chest2000; 117: 117–124. Crossref, Medline, Google Scholar
38 WinnRE, Kollef MH, Meyer JI. Pulmonary involvement in the hypereosinophilic syndrome. Chest1994; 105: 656–660. Crossref, Medline, Google Scholar
39 ChusidMJ, Dale DC, West BC, Wolff SM. The hypereosinophilic syndrome: analysis of fourteen cases with review of the literature. Medicine1975; 54: 1–27. Crossref, Medline, Google Scholar
40 SpryCJ, Davies J, Tai PC, Olsen EG, Oakley CM, Goodwin JF. Clinical features of fifteen patients with the hypereosinophilic syndrome. Q J Med1983 Winter; 52(205): 1–22. Medline, Google Scholar
41 ParrilloJE, Borer JS, Henry WL, Wolff SM, Fauci AS. The cardiovascular manifestations of the hypereosinophilic syndrome: prospective study of 26 patients, with review of the literature. Am J Med1979; 67: 572–582. Crossref, Medline, Google Scholar
42 FauciAS, Harley JB, Roberts WC, Ferrans VJ, Gralnick HR, Bjornson BH. The idiopathic hypereosinophilic syndrome: clinical, pathophysiologic, and therapeutic considerations. Ann Intern Med1982; 97: 78–92. Crossref, Medline, Google Scholar
43 SpryCJ. The hypereosinophilic syndrome: clinical features, laboratory findings and treatment. Allergy1982; 37: 539–551. Crossref, Medline, Google Scholar
44 SlabbynckH, Impens N, Naegels S, Dewaele M, Schandevyl W. Idiopathic hypereosinophilic syndrome-related pulmonary involvement diagnosed by bronchoalveolar lavage. Chest1992; 101: 1178–1180. Crossref, Medline, Google Scholar
45 EpsteinDM, Taormina V, Gefter WB, Miller WT. The hypereosinophilic syndrome. Radiology1981; 140: 59–62. Link, Google Scholar
46 KangEY, Shim JJ, Kim JS, Kim KI. Pulmonary involvement of idiopathic hypereosinophilic syndrome: CT findings in five patients. J Comput Assist Tomogr1997; 21(4): 612–615. Crossref, Medline, Google Scholar
47 WangJL, Patterson R, Rosenberg M, Roberts M, Cooper BJ. Serum IgE and IgG antibody activity against Aspergillus fumigatus as a diagnostic aid in allergic bronchopulmonary aspergillosis. Am Rev Respir Dis1978; 117: 917–927. Medline, Google Scholar
48 RosenbergM, Patterson R, Mintzer R, Cooper BJ, Roberts M, Harris KE. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med1977; 86: 405–414. Crossref, Medline, Google Scholar
49 RickettiAJ, Greenberger PA, Patterson R. Serum IgE as an important aid in management of allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol1984; 74: 68–71. Crossref, Medline, Google Scholar
50 BoskenCH, Myers JL, Greenberger PA, Katzenstein AL. Pathologic features of allergic bronchopulmonary aspergillosis. Am J Surg Pathol1988; 12: 216–222. Crossref, Medline, Google Scholar
51 PattersonR, Greenberger PA, Radin RC, Roberts M. Allergic bronchopulmonary aspergillosis: staging as an aid to management. Ann Intern Med1982; 96: 286–291. Crossref, Medline, Google Scholar
52 McCarthyDS, Simon G, Hargreave FE. The radiological appearances in allergic bronchopulmonary aspergillosis. Clin Radiol1970; 21: 366–375. Crossref, Medline, Google Scholar
53 MendelsonEB, Fisher MR, Mintzer RA, Halwig JM, Greenberger PA. Roentgenographic and clinical staging of allergic bronchopulmonary aspergillosis. Chest1985; 87: 334–339. Crossref, Medline, Google Scholar
54 NeeldDA, Goodman LR, Gurney JW, Greenberger PA, Fink JN. Computerized tomography in the evaluation of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis1990; 142: 1200–1205. Crossref, Medline, Google Scholar
55 MintzerRA, Rogers LF, Kruglik GD, Rosenberg M, Neiman HL, Patterson R. The spectrum of radiologic findings in allergic bronchopulmonary aspergillosis. Radiology1978; 127: 301–307. Link, Google Scholar
56 FranquetT, Muller NL, Gimenez A, Guembe P, de La Torre J, Bague S. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. RadioGraphics2001; 21: 825–837. Link, Google Scholar
57 AngusRM, Davies ML, Cowan MD, McSharry C, Thomson NC. Computed tomographic scanning of the lung in patients with allergic bronchopulmonary aspergillosis and in asthmatic patients with a positive skin test to Aspergillus fumigatus. Thorax1994; 49: 586–589. Crossref, Medline, Google Scholar
58 WardS, Heyneman L, Lee MJ, Leung AN, Hansell DM, Muller NL. Accuracy of CT in the diagnosis of allergic bronchopulmonary aspergillosis in asthmatic patients. AJR Am J Roentgenol1999; 173: 937–942. Crossref, Medline, Google Scholar
59 LiebowAA. The J. Burns Amberson lecture: pulmonary angiitis and granulomatosis. Am Rev Respir Dis1973; 108: 1–18. Medline, Google Scholar
60 KatzensteinAL, Liebow AA, Friedman PJ. Bronchocentric granulomatosis, mucoid impaction and hypersensitivity reaction to fungi. Am Rev Respir Dis1975; 111: 497–537. Medline, Google Scholar
61 RobinsonRG, Wehunt WD, Tsou E, Koss MN, Hochholzer L. Bronchocentric granulomatosis: roentgenographic manifestations. Am Rev Respir Dis1982; 125: 751–756. Medline, Google Scholar
62 WardS, Heyneman LE, Flint JD, Leung AN, Kazerooni EA, Muller NL. Bronchocentric granulomatosis: computed tomographic findings in five patients. Clin Radiol2000; 55: 296–300. Crossref, Medline, Google Scholar
63 JamilSA, Hilton E. The strongyloides hyperinfection syndrome. N Y State J Med1992; 92: 67–68. Medline, Google Scholar
64 LeeHK, Jin SL, Lee HP, Choi SJ, Yum HK. Loffler’s syndrome associated with Clonorchis sinensis infestation. Korean J Intern Med2003; 18: 255–259. Crossref, Medline, Google Scholar
65 UdwadiaFE. Tropical eosinophilia: a correlation of clinical, histopathologic and lung function studies. Dis Chest1967; 52: 531–538. Crossref, Medline, Google Scholar
66 KhooFY, Danaraj TJ. The roentgenographic appearance of eosinophilic lung (tropical eosinophilia). Am J Roentgenol Radium Ther Nucl Med1960; 83: 251–259. Medline, Google Scholar
67 GopinathR, Nutman TB. Parasitic diseases. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine. 3rd ed. Philadelphia, Pa: Saunders, 2000; 1143–1171. Google Scholar
68 NguyenLQ, Estrella J, Jett EA, Grunvald EL, Nicholson L, Levin DL. Acute schistosomiasis in nonimmune travelers: chest CT findings in 10 patients. AJR Am J Roentgenol2006; 186: 1300–1303. Crossref, Medline, Google Scholar
69 WaldmanAD, Day JH, Shaw P, Bryceson AD. Subacute pulmonary granulomatous schistosomiasis: high resolution CT appearances—another cause of the halo sign. Br J Radiol2001; 74: 1052–1055. Crossref, Medline, Google Scholar
70 ImJG, Kong Y, Shin YM, et al. Pulmonary paragonimiasis: clinical and experimental studies. RadioGraphics1993; 13: 575–586. Link, Google Scholar
71 KimTS, Han J, Shim SS, et al. Pleuropulmonary paragonimiasis: CT findings in 31 patients. AJR Am J Roentgenol2005; 185: 616–621. Crossref, Medline, Google Scholar
72 ImJG, Whang HY, Kim WS, Han MC, Shim YS, Cho SY. Pleuropulmonary paragonimiasis: radiologic findings in 71 patients. AJR Am J Roentgenol1992; 159: 39–43. Crossref, Medline, Google Scholar
73 WatanabeS, Nakamura Y, Kariatsumari K, et al. Pulmonary paragonimiasis mimicking lung cancer on FDG-PET imaging. Anticancer Res2003; 23: 3437–3440. Medline, Google Scholar
74 IwahashiN, Suzuki F, Tamura S, et al. A case of paragonimiasis Miyazakii with bilateral pleural and pericardial effusion [in Japanese]. Nihon Kyobu Shikkan Gakkai Zasshi1991; 29: 1047–1051. Medline, Google Scholar
75 KilbourneEM, Rigau-Perez JG, Heath CW Jr, et al. Clinical epidemiology of toxic-oil syndrome: manifestations of a new illness. N Engl J Med1983; 309: 1408–1414. Crossref, Medline, Google Scholar
76 SilverRM, Heyes MP, Maize JC, Quearry B, Vionnet-Fuasset M, Sternberg EM. Scleroderma, fasciitis, and eosinophilia associated with the ingestion of tryptophan. N Engl J Med1990; 322: 874–881. Crossref, Medline, Google Scholar
77 WolkensteinP, Chosidow O. Cutaneous adverse drug reaction with pulmonary involvement [in French]. Rev Mal Respir2003; 20(5 pt 1): 719–726. Medline, Google Scholar
78 PietraGG. Pathologic mechanisms of drug-induced lung disorders. J Thorac Imaging1991; 6: 1–7. Crossref, Medline, Google Scholar
79 SouzaCA, Muller NL, Johkoh T, Akira M. Drug-induced eosinophilic pneumonia: high-resolution CT findings in 14 patients. AJR Am J Roentgenol2006; 186: 368–373. Crossref, Medline, Google Scholar
80 ChurgJ, Strauss L. Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Pathol1951; 27: 277–301. Medline, Google Scholar
81 MasiAT, Hunder GG, Lie JT, et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis angiitis). Arthritis Rheum1990; 33: 1094–1100. Crossref, Medline, Google Scholar
82 ChumbleyLC, Harrison EG Jr, DeRemee RA. Allergic granulomatosis and angiitis (Churg-Strauss syndrome): report and analysis of 30 cases. Mayo Clin Proc1977; 52: 477–484. Medline, Google Scholar
83 ShimboJ, Onodera O, Tanaka K, Tsuji S. Churg-Strauss syndrome and the leukotriene receptor antagonist pranlukast. Clin Rheumatol2005; 24: 661–662. Crossref, Medline, Google Scholar
84 KinoshitaM, Shiraishi T, Koga T, Ayabe M, Rikimaru T, Oizumi K. Churg-Strauss syndrome after corticosteroid withdrawal in an asthmatic patient treated with pranlukast. J Allergy Clin Immunol1999; 103: 534–535. Crossref, Medline, Google Scholar
85 WechslerME, Garpestad E, Flier SR, et al. Pulmonary infiltrates, eosinophilia, and cardiomyopathy following corticosteroid withdrawal in patients with asthma receiving zafirlukast. JAMA1998; 279: 455–457. Crossref, Medline, Google Scholar
86 WorthySA, Muller NL, Hansell DM, Flower CD. Churg-Strauss syndrome: the spectrum of pulmonary CT findings in 17 patients. AJR Am J Roentgenol1998; 170: 297–300. Crossref, Medline, Google Scholar

Article History

Published in print: May 2007

Vol. 27, No. 3

Metrics

Altmetric Score

PDF download