Eosinophilic pneumonia CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

CT

• At the onset of AEP, the chest radiograph may show only subtle reticular or ground glass opacities, often with Kerley B lines. [58,59]
• As the disease progresses, bilateral diffuse mixed ground glass and reticular opacities develop [1,2,9,39-42,59] (image 1A-B).
• Isolated ground glass (approximately 25 percent of cases) or reticular (approximately 25 percent of cases) opacities may also be seen on presentation. The distribution of opacities in AEP is diffuse, unlike chronic eosinophilic pneumonia, in which the opacities are typically localized to the lung periphery.
• Small pleural effusions are common (noted in up to 70 percent of patients) and are frequently bilateral [8,45,48].
• High resolution computed tomography (HRCT) scans are not essential to the diagnosis, but can help characterize the distribution of opacities and guide selection of an area of involvement for bronchoalveolar lavage. The HRCT is always abnormal in patients with AEP and is characterized by bilateral, random, and patchy ground-glass or reticular opacities (image 2) [19,60]. Centrilobular nodules and air-space consolidation are seen in approximately 50 and 40 percent, respectively [19].
• In mild cases, the lesions are sparse or localized [41,61]. At the height of the disease process, HRCT reveals ground-glass opacities along the bronchovascular bundles. Pleural effusions, usually bilateral, are present in almost 90 percent.
• bilateral ground-glass areas: common  
• interlobular septal thickening: common
• pleural effusions: can be present in ~80% (range 60-100%) of cases
• thickening of bronchovascular bundles: present in around two-thirds of cases
• air-space consolidation: present in around half of cases
• ill-defined centrilobular nodules: present in around one-third of cases

Characteristic CT findings of CEP include:

• bilateral consolidative opacities and areas of ground-glass attenuation, involving predominantly the peripheral regions of the middle or upper lung zones [43,61-63].
• Common CT findings of ABPA consist of bronchiectasis, mucous plugging, bronchial wall thickening, atelectasis, consolidation, areas of ground-glass attenuation, and upper and central lung predominance [61]. The first three of these findings are the most indicative of ABPA.
• CT findings in AEP include ground-glass attenuation, consolidation, poorly defined nodules, interlobular septal thickening, and pleural effusions (image 7). The triad of interlobular septal thickening, bronchovascular bundle thickening, and pleural effusions are most suggestive of this diagnosis [61].
• CT findings in EGPA [64], drug-induced pulmonary eosinophilia [65], hypereosinophilic syndrome (HES), and simple pulmonary eosinophilia are varied and diverse. Thus, a radiologic diagnosis of these entities is rarely possible [61].