Presentation
Increased shortnes of breath. Cough. Increased inflamatory makers. Lower respiratory tract infection?
Patient Data
The heart is not enlarged and mediastinal contours are normal.
Within both upper zones, there is patchy consolidation consistent with infectious or inflammatory change.
Lungs are now clear.
Case Discussion
This patient initially presented with symptoms of lower respiratory tract infection. However, serum hematology revealed an eosinophilia and chest x-ray revealed an atypical pattern of bilateral upper zone consolidation.
The chest x-ray has the classic 'reverse bat's wing' pattern of eosinophilic pneumonia. Subsequent CT confirmed the plain film findings of consolidation, plus additional mediastinal lymphadenopathy.
The patient was immunocompetent with no significant past medical history. A subsequent bronchoscopic alveolar lavage revealed abundant eosinophils, 90% of the inflammatory cell component, and no evidence of malignant cells.
The patient responded well to oral corticosteroids.
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