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Acute Hypersensitivity Pneumonitis

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a

 

 

b

 

 

 

 

 

 

 

Fig. 21.8 Acute eosinophilic pneumonia in a 57-year-old man. Patient complains of cough and sputum. (a) Lung window of CT scan (5.0-mm section thickness) obtained at level of right middle lobar bronchus shows subpleural areas of ground-glass opacity particularly in posterior

aspects. Also note smooth interlobular septal thickening (arrows). (b) Coronal reformatted image (2.0-mm section thickness) demonstrates patchy area of parenchymal opacity and smooth interlobular septal thickening (arrows)

Key Points for Differential Diagnosis

 

 

Distribution

 

 

 

 

 

 

 

Zones

 

 

 

Clinical presentations

 

 

Diseases

 

U

M

L SP

C R

BV R

Acute Subacute Chronic

 

Others

 

 

Acute HP

+

+

+

+

+

+

 

Unknown causes, immediately after heavy smoking

Pneumocystis

+

+

+

+

+

+

 

AIDS, transplanted patients

pneumonia

 

 

 

 

 

 

 

 

 

CMV pneumonia

+

+

+

+

+

+

 

Immunocompromised patients

Pulmonary edema

+

+

+

+

+

+

 

With smooth interlobular septal thickening

DAH

+

+

+

+

+

+

 

Hemoptysis, anemia, pulmonary vasculitis

 

 

 

 

 

 

 

 

 

Interlobular septal thickening

AIP

+

+

+

+

+

+

 

Idiopathic diffuse alveolar damage

AEP

+

+

+

+

+

+

 

With smooth interlobular septal thickening or

 

 

 

 

 

 

 

 

 

cardiomegaly

Note: HP hypersensitivity pneumonitis, CMV cytomegalovirus, DAH diffuse alveolar hemorrhage, AIP acute interstitial pneumonia, AEP acute eosinophilic pneumonia, U upper, M middle, L lower, SP subpleural, C central, R random, BV bronchovascular, AIDS acquired immune deÞciency syndrome

Acute Hypersensitivity Pneumonitis

Pathology and Pathogenesis

The current classiÞcation of HP in acute, subacute, and chronic phases is now challenged. Cellular nonspeciÞc interstitial pneumonitis and cryptogenic organizing pneumonia patterns may be the sole histologic expression of the disease [37].

Symptoms and Signs

Symptoms of acute HP occur abruptly, a few hours after exposure to the provoking antigen [24]. It consists of a ßulike syndrome characterized by fever, chills, headache, and malaise. Patients may present with severe dyspnea, chest tightness, and nonproductive cough. The episodes subside within 24Ð48 h once the patient is removed from the antigen