pulmonary disorders
Acute Eosinophilic Pneumonia
Diagnosis of Acute Eosinophilic Pneumonia
High-resolution CT (HRCT) Usually complete blood count (CBC) with differential, pleural fluid analysis (if present), and pulmonary function testing Bronchoscopy for lavage and, sometimes, biopsy The diagnosis of acute eosinophilic pneumonia is suspected in patients with symptoms of acute pneumonia that progress to respiratory failure and do not respond to antibiotics. Diagnosis is based on findings from routine testing and is confirmed by bronchoscopy. Acute eosinophilic pneumonia is a diagnosis of exclusion and requires the absence of known causes of eosinophilic pneumonia (eg, drug- and toxin-induced, helminthic and fungal infection–related, Eosinophilic Granulomatosis with Polyangiitis (EGPA) , The CBC with differential often fails to demonstrate markedly elevated eosinophil counts, unlike in Chronic Eosinophilic Pneumonia . Erythrocyte sedimentation rate (ESR) and IgE levels are high but are nonspecific. The chest x-ray initially may show only subtle reticular or ground-glass opacities, often with Kerley B lines. Isolated alveolar (about 25% of cases) or reticular (about 25% of cases) opacities may also be observed. Unlike in chronic eosinophilic pneumonia, in acute eosinophilic pneumonia opacities are not characteristically localized to the lung periphery. Small Pleural Effusion occur in two thirds of patients and are frequently bilateral. HRCT is always abnormal with bilateral, random, patchy ground-glass or reticular opacities. Pleural fluid examination shows marked eosinophilia and high pH. Overview of Tests of Pulmonary Function (PFTs) are not diagnostic but often show a restrictive process with reduced diffusing capacity for carbon monoxide (DLCO). Bronchoscopy should be done for lavage and, occasionally, biopsy. Bronchoalveolar lavage fluid often shows a high number and percentage ( 