Akut eozinofilik pnömoni BT bulguları

Özet

Akut eozinofilik pnömoni, günler içinde ağır hipoksemiye ilerleyebilen ve başlangıçta periferik eozinofil artışı bulunmayabilen akut bir akciğer hastalığıdır. Akut eozinofilik pnömonide HRCT, bilateral buzlu cam opasitelerini, konsolidasyonları ve interlobüler septal kalınlaşmayı gösterebilir; bu bulgular tanıdan çok görüntüleme örüntüsünü tanımlar. Görüntü kardiyojenik ödem ve ARDS ile örtüşebildiğinden klinik bağlam ve bronkoalveoler lavaj bulgusu tanısal ayrımda önem taşır. Akut eozinofilik pnömoni ağır toplum kökenli pnömoni veya ARDS’yi taklit edebilir ve bu nedenle tanısı gecikebilir.

Faz ve pencere

HRCT tanısal: HRCT’de iki akciğerde yaygın veya yamalı buzlu cam opasiteleri, konsolidasyonlar ve interlobüler septal kalınlaşma görülebilir; plevral efüzyon da eşlik edebilir. Akut eozinofilik pnömonide bilateral buzlu cam opasiteleri, konsolidasyonlar ve interlobüler septal kalınlaşma gibi parankimal bulguları göstermek için yüksek çözünürlüklü bilgisayarlı tomografi (HRCT) kullanılır.

Önerilen pencereler G genişlik, M merkez; değerler Hounsfield birimi (HU)

AkciğerG 1500 / M −600
MediastenG 350 / M +50

BT bulguları

Bilateral buzlu cam — damar sınırları opasite içinden seçilir; dağılım yamalı, simetrik ya da yaygın olabilir.
BT’de yamalı alveoler opasiteler veya yaygın buzlu cam opasiteleri görülebilir.
Düzgün interlobüler septal kalınlaşma — sekonder lobül kenarlarında ince, eşit kalınlıklı çizgiler oluşturur.
İnterlobüler septal kalınlaşma düzgün çizgiler oluşturabilir; düzgün septal kalınlaşma pulmoner ödemde görülebilir.
İki taraflı plevral efüzyon — küçük ya da orta miktarda sıvı eşlik edebilir ve ödem benzeri görünümü güçlendirir.
Nodüler buzlu cam opasiteleri — bazı olgularda küçük nodüler alanlar eşlik eder; baskın bulgu değildir.
Akut eozinofilik pnömonide interlobüler septal kalınlaşma görülebilir.

Normalde

Akut eozinofilik pnömonide HRCT'de buzlu cam opasiteleri ve konsolidasyonlar görülebilir.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s1278; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Akut eozinofilik pnömonide akciğer grafisi pulmoner ödemle uyumlu bir görünüm gösterebilir.
ARDS, akut eozinofilik pnömoniyle klinik olarak benzerlik gösterebilir.
Diffüz alveoler kanamada BT’de yaygın buzlu cam opasiteleri ve septal kalınlaşma görülebilir.
İdiyopatik akut eozinofilik pnömoni enfeksiyöz pnömoni olarak yanlış tanınabilir.
Akut interstisyel pnömoni: yaygın akut hasar ve DAD örüntüsü oluşturabilir; BT tek başına eozinofilik nedeni ayıramaz.

Tuzaklar

Başlangıçta periferik kan eozinofilisi olmayabilir; normal kan sayımı HRCT örüntüsünü dışlamaz.
İki taraflı plevral efüzyon ve interlobüler septal kalınlaşma akut idiyopatik eozinofilik pnömonide de görülebilir.
Bilateral buzlu camı eozinofilik pnömoniye özgü saymayın; ARDS, kanama ve enfeksiyon da benzer olabilir.
Yeni ilaç öyküsü ve özellikle yakın zamanda sigaraya başlama öyküsü sorgulanmalıdır; ilaçlar ve sigara maruziyeti akut eozinofilik pnömoniyle ilişkilendirilmiştir.

Kendini dene

Akut ateş ve hipoksemide bilateral yamalı buzlu cam, düzgün septalar ve küçük plevral efüzyon var; bronkoalveoler lavajda eozinofiller >%25. En uygun tanı hangisidir?
Cevabı göster
Akut eozinofilik pnömoni. Akut başlangıçlı hipoksemik tabloda bronkoalveoler lavajda >%25 eozinofil akut eozinofilik pnömoniyi destekleyen tanı ölçütüdür; BT’de bilateral buzlu cam, septal kalınlaşma ve efüzyon eşlik edebilir. Görüntü tek başına özgül değildir; başka bilinen nedenlerin klinik olarak dışlanması gerekir.
Akut eozinofilik pnömoni için bronkoalveoler lavajda hangi bulgu tanı ölçütleri arasında yer alır?
Cevabı göster
Eozinofillerin %25’ten fazla olması. Akut eozinofilik pnömoni tanı ölçütleri arasında BAL sıvısında %25’ten fazla eozinofil bulunması yer alır. WAP, AEP ve HP'de BAL'da baskın hücreler sırasıyla makrofajlar, eozinofiller ve lenfositlerdir.

İlgili konular

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 17 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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