Peripheral opacities in chronic eosinophilic pneumonia: the photographic negative of pulmonary edema

Abstract

To test whether there is a radiographic pattern diagnostic for chronic eosinophilic pneumonia (CEP), radiographs of 591 patients with interstitial lung disease (2,852 films) were reviewed. A peripheral ground glass pattern was seen in 24 individuals (4.1%). Lung biopsies in 16 of these patients revealed CEP. The remaining eight bad all the clinical features of CEP. In a separate study, pathologic featues of 350 patients with interstitial disease were coded: CEP was the principal diagnosis in 21 (5.7%). Sixteen of the 21 had typical peripheral radiographic opacities. Review of published chest radiographs of 81 patients with CEP showed characteristic peripheral opacities in 53 cases (65%). Typically, dense opacities with ill-defined margins and without lobar or segmental distribution are seen arranged peripherally apposed to the pleura. The opacities are usually in an apical or axillary location, but are sometimes basal when they mimic loculated effusion. When the opacities surround the lung, the appearance...