Asunto(s)
Eosinofilia Pulmonar/diagnóstico , Adulto , Algoritmos , Líquido del Lavado Bronquioalveolar/citología , Broncoscopía , Diagnóstico Diferencial , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Eosinófilos , Femenino , Humanos , Recuento de Leucocitos , Mediciones del Volumen Pulmonar , Prednisona/uso terapéutico , Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
Chronic eosinophilic pneumonia. The chronic eosinophilic pneumonia is part of Pulmonary Eosinophilic Syndroms. It is presented a 33-years old man, Asmathic, with dry cough, fever, night sweats and fatigue of several weeks. The chest X-ray showed opacity in the right hemithorax. He was treated with antibiotics without response. A chest TC showed multifocal involvement. The patient refused bronchoalveolar lavage (BAL) so treatment antituberculostatic was started. Despite treatment the symptoms worsened. The Chest X-ray showed migration of the infiltrates and the blood smear marked eosinophilia. Finally, bronchoalveolar lavage was carried out and it showed a high percentage of eosinophils (over 50%). The patient was treated with inmmunosuppresive doses of corticosteroids with excellent response. The blood smear in Nonresolving pneumonia is key to consider eosinophilic pneumonia, an uncommon pathology but amenable to treatment.
Asunto(s)
Eosinofilia Pulmonar/diagnóstico , Adulto , Humanos , Masculino , Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/diagnóstico por imagen , RadiografíaRESUMEN
Pulmonary eosinophilias belong to a heterogenous group of the diseases characterized by pulmonary shadows related to pulmonary tissue and/or peripheral blood eosinophilia. Although the inflammatory infiltrate consists of macrophages, lymphocytes, neutrophils and eosinophils, a significant marker for the diagnosis and treatment is eosinophilia. By etiology eosinophilic diseases of the lungs fall into primary or idiopathic (common pulmonary eosinophilia, chronic eosinophilic pneumonia, hypereosinophilic syndrome), secondary or of known origin (allergic bronchopulmonary aspergillesis, bronchocentric granulematosis, parasitic invasions, drug-induced reactions, fungal and mycobacterial infection, pulmonary diseases caused by radiation or toxins). Pulmonary eosinophilia can be also associated with systemic diseases (Churg-Strauss syndrome) and tumors. Clinicoroentgenological picture of different eosinophilic diseases of the lungs is almost the same. Verification of the diagnosis is based on the presence of bronchial asthma and extrapulmonary manifestations, the level of eosinophilia in the blood, bronchoalveolar lavage and total IgE, histological and chest CT findings. This article presents modern classification, clinicoroentgenological and histological characteristics of different, primarily idiopathic, eosinophilic diseases of the lungs.
Asunto(s)
Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/diagnóstico , Humanos , Inflamación/sangre , Inflamación/clasificación , Inflamación/diagnósticoRESUMEN
Accurate diagnosis of eosinophilic lung diseases is essential to optimizing patient outcomes, but remains challenging. Signs and symptoms frequently overlap among the disorders, and because these disorders are infrequent, expertise is difficult to acquire. Still, these disorders are not rare, and most clinicians periodically encounter patients with one or more of the eosinophilic lung diseases and need to understand how to recognize, diagnose, and manage these diseases. This review focuses on the clinical features, general diagnostic workup, and management of the eosinophilic lung diseases.
Asunto(s)
Eosinofilia/diagnóstico , Enfermedades Pulmonares/diagnóstico , Aspergilosis Broncopulmonar Alérgica/diagnóstico , Aspergilosis Broncopulmonar Alérgica/fisiopatología , Broncoscopía , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/diagnóstico por imagen , Síndrome de Churg-Strauss/tratamiento farmacológico , Síndrome de Churg-Strauss/patología , Comorbilidad , Diagnóstico Diferencial , Progresión de la Enfermedad , Eosinofilia/clasificación , Humanos , Síndrome Hipereosinofílico/clasificación , Síndrome Hipereosinofílico/diagnóstico , Síndrome Hipereosinofílico/tratamiento farmacológico , Síndrome Hipereosinofílico/inmunología , Enfermedades Pulmonares/clasificación , Enfermedades Pulmonares Intersticiales/diagnóstico , Alveolos Pulmonares/patología , Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/diagnóstico , Eosinofilia Pulmonar/epidemiología , Eosinofilia Pulmonar/patología , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/microbiología , Enfermedades Reumáticas/diagnóstico , Tomografía Computarizada por Rayos X/métodosRESUMEN
Los síndromes de infiltrados pulmonares con eosinofilia (síndromes PIE) constituyen un grupo heterogéneo de desórdenes poco frecuentes, de diferente etiopatogenia y presentación clínica variable. Estos cuadros tienen en común la presencia de infiltrados pulmonares y eosinofilia periférica, en el lavado broncoalveolar y en el intersticio pulmonar; aunque además pueden existir síntomas sistémicos. Actualmente se recomienda clasificar a los síndromes PIE según la etiología en idiopáticos y secundarios. Dentro de los primeros se encuentran la eosinofilia pulmonar simple (síndrome de Loeffler), neumonía eosinofílica aguda, neumonía eosinofílica crónica, síndrome hipereosinofílico idiopático, granulomatosis alérgica o síndrome de Churg- Strauss y granulomatosis broncocéntrica. Los secundarios incluyen la aspergilosis broncopulmonar alérgica, eosinofilia inducida por parásitos (forma más frecuente en pediatría) y por drogas. Los corticoides constituyen el tratamiento de elección, en cambio cuando la etiología son parásitos la terapia debe ser hecha con fármacos antiparasitarios. Se debe tener un alto índice de sospecha en el diagnóstico, debido a la escasa frecuencia que presentan estos síndromes y a la significativa morbilidad y en ocasiones mortalidad, especialmente la neumonía eosinofílica aguda, que se manifiesta frecuentemente con insuficiencia respiratoria severa de etiología desconocida.
Asunto(s)
Humanos , Niño , Eosinofilia Pulmonar/diagnóstico , Eosinofilia Pulmonar/terapia , Enfermedad Aguda , Algoritmos , Lavado Broncoalveolar , Enfermedad Crónica , Corticoesteroides/uso terapéutico , Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/etiología , Parásitos/patogenicidad , Preparaciones Farmacéuticas/efectos adversos , SíndromeRESUMEN
Pulmonary eosinophilia comprises a heterogeneous group of diseases defined by eosinophilia in pulmonary infiltrates (bronchoalveolar lavage fluid) or in tissue (lung biopsy specimens). Although the inflammatory infiltrate is composed of macrophages, lymphocytes, neutrophils and eosinophils, eosinophilia is an important marker for the diagnosis and treatment. Clinical and radiological presentations can include simple pulmonary eosinophilia, chronic eosinophilic pneumonia, acute eosinophilic pneumonia, allergic bronchopulmonary aspergillosis and pulmonary eosinophilia associated with a systemic disease, such as in Churg-Strauss syndrome and hypereosinophilic syndrome. Asthma is frequently concomitant and can be a prerequisite, as in allergic bronchopulmonary aspergillosis and Churg-Strauss syndrome. In diseases with systemic involvement, the skin, the heart and the nervous system are the most affected organs. The radiological presentation can be typical, or at least suggestive, of one of three types of pulmonary eosinophilia: chronic eosinophilic pneumonia, acute eosinophilic pneumonia and allergic bronchopulmonary aspergillosis. The etiology of pulmonary eosinophilia can be either primary (idiopathic) or secondary, due to known causes, such as drugs, parasites, fungal infection, mycobacterial infection, irradiation and toxins. Pulmonary eosinophilia can be also associated with diffuse lung diseases, connective tissue diseases and neoplasia.
Asunto(s)
Eosinofilia Pulmonar , Enfermedad Aguda , Enfermedad Crónica , Humanos , Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/diagnóstico , Eosinofilia Pulmonar/tratamiento farmacológicoRESUMEN
As formas de eosinofilia pulmonar constituem um grupo heterogêneo definido pela presença de um ou dois critérios: infiltrado pulmonar com eosinofilia sanguínea e/ou eosinofilia tissular caracterizada por eosinófilos demonstrados na biópsia pulmonar ou no lavado broncoalveolar. Embora o infiltrado inflamatório seja composto de macrófagos, linfócitos, neutrófilos e eosinófilos, a presença de eosinofilia é um marcador importante para o diagnóstico e tratamento. A apresentação clínica e radiológica pode revelar eosinofilia pulmonar simples, pneumonia eosinofílica crônica, pneumonia eosinofílica aguda, aspergilose broncopulmonar alérgica e eosinofilia pulmonar associada à doença sistêmica, como na síndrome de Churg-Strauss e na síndrome hipereosinofílica. A asma está frequentemente associada, podendo ser um pré-requisito, como na aspergilose broncopulmonar alérgica e na síndrome de Churg-Strauss. Nas doenças com acometimento sistêmico, a pele, o coração e o sistema nervoso são os órgãos mais comprometidos. A apresentação radiológica pode ser considerada como típica, ou pelo menos sugestiva, para três formas de eosinofilia pulmonar: pneumonia eosinofílica crônica, aspergilose broncopulmonar alérgica e pneumonia eosinofílica aguda. A etiologia da eosinofilia pulmonar pode ser de causa primária (idiopática) ou secundária, compreendendo causas conhecidas, como drogas, parasitas, infecções por fungos e micobactérias, irradiação e toxinas. A eosinofilia pulmonar pode também estar associada a doenças pulmonares difusas, doenças do tecido conectivo e neoplasias.
Pulmonary eosinophilia comprises a heterogeneous group of diseases defined by eosinophilia in pulmonary infiltrates (bronchoalveolar lavage fluid) or in tissue (lung biopsy specimens). Although the inflammatory infiltrate is composed of macrophages, lymphocytes, neutrophils and eosinophils, eosinophilia is an important marker for the diagnosis and treatment. Clinical and radiological presentations can include simple pulmonary eosinophilia, chronic eosinophilic pneumonia, acute eosinophilic pneumonia, allergic bronchopulmonary aspergillosis and pulmonary eosinophilia associated with a systemic disease, such as in Churg-Strauss syndrome and hypereosinophilic syndrome. Asthma is frequently concomitant and can be a prerequisite, as in allergic bronchopulmonary aspergillosis and Churg-Strauss syndrome. In diseases with systemic involvement, the skin, the heart and the nervous system are the most affected organs. The radiological presentation can be typical, or at least suggestive, of one of three types of pulmonary eosinophilia: chronic eosinophilic pneumonia, acute eosinophilic pneumonia and allergic bronchopulmonary aspergillosis. The etiology of pulmonary eosinophilia can be either primary (idiopathic) or secondary, due to known causes, such as drugs, parasites, fungal infection, mycobacterial infection, irradiation and toxins. Pulmonary eosinophilia can be also associated with diffuse lung diseases, connective tissue diseases and neoplasia.
Asunto(s)
Humanos , Eosinofilia Pulmonar , Enfermedad Aguda , Enfermedad Crónica , Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/diagnóstico , Eosinofilia Pulmonar/tratamiento farmacológicoRESUMEN
Eosinophilic lung diseases are a diverse group of pulmonary disorders associated with peripheral or tissue eosinophilia. They are classified as eosinophilic lung diseases of unknown cause (simple pulmonary eosinophilia [SPE], acute eosinophilic pneumonia [AEP], chronic eosinophilic pneumonia [CEP], idiopathic hypereosinophilic syndrome [IHS]), eosinophilic lung diseases of known cause (allergic bronchopulmonary aspergillosis [ABPA], bronchocentric granulomatosis [BG], parasitic infections, drug reactions), and eosinophilic vasculitis (allergic angiitis, granulomatosis [Churg-Strauss syndrome]). The percentages of eosinophils in peripheral blood and bronchoalveolar lavage fluid are essential parts of the evaluation. Chest computed tomography (CT) demonstrates a more characteristic pattern and distribution of parenchymal opacities than does conventional chest radiography. At CT, SPE and IHS are characterized by single or multiple nodules with a surrounding ground-glass-opacity halo, AEP mimics radiologically hydrostatic pulmonary edema, and CEP is characterized by nonsegmental airspace consolidations with peripheral predominance. ABPA manifests with bilateral central bronchiectasis with or without mucoid impaction. The CT manifestations of BG are nonspecific and consist of a focal mass or lobar consolidation with atelectasis. The most common CT findings in Churg-Strauss syndrome include sub-pleural consolidation with lobular distribution, centrilobular nodules, bronchial wall thickening, and interlobular septal thickening. The integration of clinical, radiologic, and pathologic findings facilitates the initial and differential diagnoses of various eosinophilic lung diseases.
Asunto(s)
Eosinofilia Pulmonar/diagnóstico por imagen , Eosinofilia Pulmonar/patología , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Eosinofilia Pulmonar/clasificaciónRESUMEN
Considerable confusion exists regarding the proper classification of idiopathic eosinophilic pneumonia (IEP). In addition, there are no reports that reveal clinicopathological differences between the various eosinophilic pneumonias. A problem persists in describing what the essential histological differences are between the different types of IEP. In this context, we examined the histological findings of acute eosinophilic pneumonia (AEP) and chronic eosinophilic pneumonia (CEP) and contrasted them with the clinical features and radiological findings. Radiologically, ground glass opacity and interlobular septal thickening were characteristic of the AEP cases studied, while air space consolidation was seen in all CEP cases. Histologically, interstitial edema and fibrin deposition were prominent in the AEP cases. Type II cells were detached from the alveolar walls, though the basal lamina was predominantly intact. In CEP, in addition to cellular infiltration, there was prominent intraluminal fibrosis. Disruption of the basal lamina was observed and nests of intraluminal fibrosis were directly adjacent and connected to the alveolar walls. From these findings, we conclude that the histological differences between AEP and CEP are the severity of basal lamina damage, the amount of subsequent intraluminal fibrosis, and the severity of interstitial edema. Especially in AEP, interstitial edema is an essential histological finding and this finding explains the acute onset, and the radiographic findings, as well as the rapid and complete improvement noted in such cases.
Asunto(s)
Eosinofilia Pulmonar/diagnóstico por imagen , Eosinofilia Pulmonar/patología , Tomografía Computarizada por Rayos X , Enfermedad Aguda , Adulto , Líquido del Lavado Bronquioalveolar/citología , Enfermedad Crónica , Femenino , Fibrosis/patología , Humanos , Masculino , Persona de Mediana Edad , Eosinofilia Pulmonar/clasificación , Radiografía TorácicaRESUMEN
OBJECTIVE: Considerable confusion exists regarding the proper classification of idiopathic eosinophilic pneumonia (IEP). Furthermore, there are no reports describing the clinicopathological differences between the various forms of eosinophilic pneumonias. METHODOLOGY: The histological findings in acute eosinophilic pneumonia (AEP) and chronic eosinophilic pneumonia (CEP) were examined and the clinical and radiological features were contrasted with them. RESULTS: Radiologically, ground glass opacity and interlobular septal thickening were characteristic of the AEP cases, while air space consolidation was seen in all CEP cases. Histologically, interstitial oedema and fibrin deposition were prominent in the AEP cases. Type II cells were detached from the alveolar walls, although the basal lamina was predominantly intact. In CEP, in addition to cellular infiltration, there was prominent intraluminal fibrosis. Disruption of the basal lamina was observed and nests of intraluminal fibrosis were directly adjacent and connected to the alveolar walls. CONCLUSIONS: An essential histological difference between AEP and CEP is the severity of basal lamina damage and the amount of subsequent intraluminal fibrosis. In AEP particularly, these findings explain the radiographical findings, as well as the rapid and complete improvement noted in such cases.
Asunto(s)
Eosinofilia Pulmonar/patología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Membrana Basal/patología , Biopsia , Lavado Broncoalveolar , Enfermedad Crónica , Femenino , Fibrina , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Persona de Mediana Edad , Alveolos Pulmonares/diagnóstico por imagen , Alveolos Pulmonares/patología , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/patología , Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/patología , Radiografía Torácica , Estudios Retrospectivos , Tomografía Computarizada por Rayos XAsunto(s)
Alveolitis Alérgica Extrínseca/epidemiología , Eosinofilia Pulmonar/epidemiología , Factores de Edad , Alveolitis Alérgica Extrínseca/clasificación , Alveolitis Alérgica Extrínseca/etiología , Causas de Muerte , Bases de Datos Factuales , Femenino , Humanos , Internet , Japón/epidemiología , Masculino , Pronóstico , Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/etiología , Factores SexualesRESUMEN
From a particular case of eosinophilic lung, we try to define a practical way to an easier diagnosis. We also review all the concerned pathologic entities and propose an aetiologic classification.
Asunto(s)
Algoritmos , Árboles de Decisión , Eosinofilia Pulmonar , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Eosinofilia Pulmonar/clasificación , Eosinofilia Pulmonar/diagnóstico , Eosinofilia Pulmonar/etiologíaRESUMEN
Eosinophilic lung disease comprises a diverse group of disorders characterized by eosinophilic pulmonary infiltration in association with other inflammatory cells. In patients with respiratory symptoms, usually associated with radiographically documented infiltrates, blood eosinophilia is a helpful but inconsistent diagnostic finding. Currently diagnosis is confirmed more often by bronchoalveolar lavage than by lung biopsy. Possible etiologies include parasites, mycotic agents, drugs, and angeitis. Remaining cases are classified as idiopathic eosinophilic lung disease including Carrington's disease, idiopathic hypereosinophilic syndrome, acute eosinophilic pneumonia, and Loeffler's syndrome. Mild eosinophilia is also a possible finding of bronchoalveolar lavage in several other disorders but the role of eosinophils is less important. The prognosis and treatment of eosinophilic lung disease varies depending on etiology. Corticosteroids are frequently used but treatment modalities also depend on etiology.