Eosinophilic pneumonia other diagnostic studies: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Eosinophilic pneumonia}} | {{Eosinophilic pneumonia}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{MAD}} | ||
==Overview== | ==Overview== | ||
In acute eosinophilic pneumonia (AEP), Pulmonary function tests show reduced [[forced vital capacity]] and [[total lung capacity]] with a normal forced expiratory volume in one second; [[Diffusion capacity|diffusing capacity]] for [[carbon monoxide]] ([[DLCO]]) is commonly reduced. [[Bronchoalveolar lavage]] (BAL) is performed in the majority of patients to exclude [[infection]], [[hemorrhage]], or [[malignancy]]. The [[Bronchoalveolar lavage|BAL]] is performed using a sequential instillation and recovery of 50 to 60 mL. The median BAL cellularity was 350,000/mm3. BAL [[eosinophilia]] was present in all cases with a median of 38%. Lung biopsy is rarely necessary to make a diagnosis of AEP in [[immunocompetent]] patients with a compatible history and prominent [[Bronchoalveolar lavage|BAL]] [[eosinophilia]] in the absence of [[infection]] or other known precipitant. | |||
==Other diagnostic studies== | ==Other diagnostic studies== | ||
'''Pulmonary function tests''' | '''Pulmonary function tests'''<ref name="pmid8982150">{{cite journal| author=Pope-Harman AL, Davis WB, Allen ED, Christoforidis AJ, Allen JN| title=Acute eosinophilic pneumonia. A summary of 15 cases and review of the literature. | journal=Medicine (Baltimore) | year= 1996 | volume= 75 | issue= 6 | pages= 334-42 | pmid=8982150 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8982150 }}</ref> | ||
* A restrictive process may be noted: Reduced [[forced vital capacity]] and [[total lung capacity]] with a normal forced expiratory volume in one second; [[Diffusion capacity|diffusing capacity]] for [[carbon monoxide]] ([[DLCO]]) is commonly reduced.<ref name="pmid8339639">{{cite journal| author=Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S| title=Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia. | journal=Chest | year= 1993 | volume= 104 | issue= 2 | pages= 493-6 | pmid=8339639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8339639 }}</ref> | |||
* | |||
'''Bronchoscopy with bronchoalveolar lavage''' | '''Bronchoscopy with bronchoalveolar lavage''' | ||
* [[Bronchoalveolar lavage]] (BAL) is performed in the majority of patients to exclude infection, hemorrhage, or malignancy.<ref name="pmid8181338">{{cite journal| author=Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M| title=A clinical study of idiopathic eosinophilic pneumonia. | journal=Chest | year= 1994 | volume= 105 | issue= 5 | pages= 1462-6 | pmid=8181338 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8181338 }}</ref> | * [[Bronchoalveolar lavage]] (BAL) is performed in the majority of patients to exclude [[infection]], [[hemorrhage]], or [[malignancy]].<ref name="pmid8181338">{{cite journal| author=Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M| title=A clinical study of idiopathic eosinophilic pneumonia. | journal=Chest | year= 1994 | volume= 105 | issue= 5 | pages= 1462-6 | pmid=8181338 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8181338 }}</ref> | ||
* The BAL is performed using a sequential instillation and recovery of 50 to 60 mL aliquots in an area of radiographic opacity | * The BAL is performed using a sequential instillation and recovery of 50 to 60 mL aliquots in an area of radiographic opacity. | ||
* In | * In acute pneumonia, the BAL fluid typically shows a very high proportion (>25 percent) and total number of [[eosinophils]].<ref name="pmid83396392">{{cite journal| author=Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S| title=Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia. | journal=Chest | year= 1993 | volume= 104 | issue= 2 | pages= 493-6 | pmid=8339639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8339639 }}</ref> | ||
* The median BAL cellularity was 350,000 | * The median BAL cellularity was 350,000/mm3. BAL [[eosinophilia]] was present in all cases with a median of 38%. | ||
* | * The proportion of BAL [[lymphocytes]] is approximately 10 to 30 percent and the proportion of BAL [[neutrophils]] is 1 to 16 percent. | ||
* The level of eosinophilia returns to normal when the illness resolves. | * The level of [[eosinophilia]] returns to normal when the illness resolves. | ||
'''Lung biopsy''' | '''Lung biopsy''' | ||
* Lung biopsy is rarely necessary to make a diagnosis of AEP in immunocompetent patients with a compatible history and prominent BAL eosinophilia in the absence of infection or | * Lung [[biopsy]] is rarely necessary to make a diagnosis of AEP in [[immunocompetent]] patients with a compatible history and prominent BAL eosinophilia in the absence of [[infection]] or another known precipitant. | ||
* Indications for lung biopsy would include concern about an infectious etiology that could not be quickly excluded by BAL or failure to respond to systemic glucocorticoids. | * Indications for lung biopsy would include concern about an infectious etiology that could not be quickly excluded by BAL or failure to respond to systemic [[glucocorticoids]]. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 04:55, 2 March 2018
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Eosinophilic pneumonia Microchapters |
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Eosinophilic pneumonia other diagnostic studies On the Web |
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American Roentgen Ray Society Images of Eosinophilic pneumonia other diagnostic studies |
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Risk calculators and risk factors for Eosinophilic pneumonia other diagnostic studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
In acute eosinophilic pneumonia (AEP), Pulmonary function tests show reduced forced vital capacity and total lung capacity with a normal forced expiratory volume in one second; diffusing capacity for carbon monoxide (DLCO) is commonly reduced. Bronchoalveolar lavage (BAL) is performed in the majority of patients to exclude infection, hemorrhage, or malignancy. The BAL is performed using a sequential instillation and recovery of 50 to 60 mL. The median BAL cellularity was 350,000/mm3. BAL eosinophilia was present in all cases with a median of 38%. Lung biopsy is rarely necessary to make a diagnosis of AEP in immunocompetent patients with a compatible history and prominent BAL eosinophilia in the absence of infection or other known precipitant.
Other diagnostic studies
Pulmonary function tests[1]
- A restrictive process may be noted: Reduced forced vital capacity and total lung capacity with a normal forced expiratory volume in one second; diffusing capacity for carbon monoxide (DLCO) is commonly reduced.[2]
Bronchoscopy with bronchoalveolar lavage
- Bronchoalveolar lavage (BAL) is performed in the majority of patients to exclude infection, hemorrhage, or malignancy.[3]
- The BAL is performed using a sequential instillation and recovery of 50 to 60 mL aliquots in an area of radiographic opacity.
- In acute pneumonia, the BAL fluid typically shows a very high proportion (>25 percent) and total number of eosinophils.[4]
- The median BAL cellularity was 350,000/mm3. BAL eosinophilia was present in all cases with a median of 38%.
- The proportion of BAL lymphocytes is approximately 10 to 30 percent and the proportion of BAL neutrophils is 1 to 16 percent.
- The level of eosinophilia returns to normal when the illness resolves.
Lung biopsy
- Lung biopsy is rarely necessary to make a diagnosis of AEP in immunocompetent patients with a compatible history and prominent BAL eosinophilia in the absence of infection or another known precipitant.
- Indications for lung biopsy would include concern about an infectious etiology that could not be quickly excluded by BAL or failure to respond to systemic glucocorticoids.
References
- ↑ Pope-Harman AL, Davis WB, Allen ED, Christoforidis AJ, Allen JN (1996). "Acute eosinophilic pneumonia. A summary of 15 cases and review of the literature". Medicine (Baltimore). 75 (6): 334–42. PMID 8982150.
- ↑ Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S (1993). "Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia". Chest. 104 (2): 493–6. PMID 8339639.
- ↑ Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M (1994). "A clinical study of idiopathic eosinophilic pneumonia". Chest. 105 (5): 1462–6. PMID 8181338.
- ↑ Ogawa H, Fujimura M, Matsuda T, Nakamura H, Kumabashiri I, Kitagawa S (1993). "Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia". Chest. 104 (2): 493–6. PMID 8339639.