CTICasesChronic Eosinophilic Pneumonia
Imaging findings
In a thin 38-year-old man with asthma and drenching night sweats, CT showed fairly symmetric peripheral upper-lobe bands of consolidation and ground-glass opacity with atoll/reverse-halo signs; peripheral eosinophilia was confirmed and the findings almost completely resolved on follow-up CT after starting steroids. A second patient, a 16-year-old woman with one to two years of intermittent cough previously misdiagnosed as chronic hypersensitivity pneumonitis and treated with multiple steroid courses, showed a similar but more striking pattern of peripheral bands of consolidation cresting into ground-glass opacity extending to the pleural surface, with eosinophilia confirmed on bronchoalveolar lavage and peripheral blood.
Key takeaways
Peripheral, upper-lobe-predominant bands of consolidation with ground-glass opacity and an atoll/reverse-halo appearance, especially with blood or BAL eosinophilia, should suggest chronic eosinophilic pneumonia, a steroid-responsive process that can dramatically resolve on follow-up imaging. It can be misdiagnosed as hypersensitivity pneumonitis or infection when eosinophilia is not specifically checked, so peripheral and BAL eosinophil counts are key confirmatory tests.
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