CTICasesPulmonary Eosinophilic Infiltration (Hyper-eosinophilic Syndrome / Eosinophilic Granulomatosis with Polyangiitis)
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Imaging findings
Serial chest CTs demonstrate waxing and waning, small, peripheral pulmonary nodules, some appearing ground glass or part solid. These nodules would disappear on subsequent scans only for new ones to emerge. Biopsy of a larger nodule revealed abundant eosinophils, giant cells, and granulomas, with special stains ruling out Langerhans cell histiocytosis.
Key takeaways
Waxing and waning pulmonary opacities, especially nodules, in a patient with peripheral eosinophilia or known hypereosinophilic syndrome are highly suggestive of eosinophilic lung disease. This can manifest as various patterns, including nodular infiltration. While biopsy can confirm eosinophilic inflammation, the clinical context is often very strong. Conditions like Eosinophilic Granulomatosis with Polyangiitis (EGPA, formerly Churg-Strauss) should be considered in such cases.
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