CTICasesEosinophilic Pneumonia and Asthma
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Imaging findings
Chest radiograph shows subtle, ill-defined perihilar and apical parenchymal opacity in the left lung. Chest CT reveals bilateral, patchy, upper-lobe-predominant ground-glass opacities. Additionally, there is prominent bronchial wall thickening accompanied by extensive mucus plugging and secretions filling multiple generations of segmental and subsegmental bronchi in both the upper and lower lobes.
Key takeaways
The constellation of asthma, peripheral blood eosinophilia, patchy ground-glass opacities, and extensive bronchial wall thickening with mucus plugging has a broad differential diagnosis. While clinicians may favor a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA, or Churg-Strauss syndrome), EGPA is a systemic vasculitis that classically requires multi-organ involvement (such as neuropathy, sinusitis, or purpura) and biopsy evidence. In many cases, these features are better explained by allergic bronchopulmonary aspergillosis (ABPA) or simple eosinophilic pneumonia, which are highly responsive to corticosteroid therapy.
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