Eosinophilic pneumonia other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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 other 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.