CTICasesAcute Eosinophilic Pneumonia of Undetermined Cause
Imaging findings
A patient had a radiograph with subtle low-grade opacity that progressed dramatically within one week to extensive bilateral consolidation with a mid-lung and basal distribution, small bilateral pleural effusions, and lymphadenopathy; CT showed multiple airway-associated and peripheral, basal-predominant consolidative opacities. Bronchoalveolar lavage showed 20% eosinophils, establishing eosinophilic pneumonia; an incidental suspicious T-cell clone and lymphadenopathy were felt not to represent malignancy and resolved along with the lung disease after steroid therapy, with no identifiable trigger (drug, supplement, or parasitic) found on workup.
Key takeaways
Rapidly progressive, basal-predominant peripheral consolidation with pleural effusions and marked lavage eosinophilia is consistent with acute eosinophilic pneumonia, distinguishable from chronic eosinophilic pneumonia's classic apical "photographic negative of pulmonary edema" pattern by its basal distribution and acute one-week evolution; a thorough search for triggers should include not just prescription and illicit drugs but also over-the-counter supplements, though in a substantial proportion of cases, as here, no cause is ultimately identified.
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