pulmonary disorders
Chronic Eosinophilic Pneumonia
Diagnosis of Chronic Eosinophilic Pneumonia
Chest x-ray and high-resolution CT (HRCT) Usually complete blood count (CBC) with differential and other laboratory tests Exclusion of infectious causes of pneumonia Bronchoalveolar lavage Diagnosis of chronic eosinophilic pneumonia is suspected in patients with characteristic symptoms and typical radiographic appearance after excluding an infectious cause of the pneumonia. Chest x-ray findings of bilateral peripheral or pleural-based opacities, most commonly in the middle and upper lung zones, are described as the photographic negative of pulmonary edema and are virtually pathognomonic (although present in<25% of patients). A similar pattern can be present on HRCT, but the distribution of consolidation can vary and even include unilateral lesions. Diagnosis also requires a complete blood count (CBC) with differential, erythrocyte sedimentation rate (ESR), IgE levels, sometimes iron studies, and exclusion of infectious causes by appropriate cultures. Peripheral blood eosinophilia, a very high ESR, iron deficiency anemia, and thrombocytosis are all frequently present. Unlike in Acute Eosinophilic Pneumonia , peripheral eosinophilia is often present in chronic eosinophilic pneumonia. Bronchoalveolar lavage is usually done to confirm the diagnosis. Eosinophilia>40% in bronchoalveolar lavage fluid is highly suggestive of chronic eosinophilic pneumonia; serial bronchoalveolar lavage examinations may help document the course of disease. 