Rapidly progressive pulmonary opacities on thoracic imaging studies

Michael B. Gotway, Paul J. Conomos

Research output: Contribution to journalArticlepeer-review


Thoracic imaging studies showing the rapid development of multifocal, bilateral pulmonary opacities are common in clinical practice. From an imaging standpoint, such patients may be broadly classified into those with hydrostatic pulmonary edema versus those with increased permeability edema patterns; combinations of these two patterns may also be encountered. Classification of patients into one or the other pattern provides an approach to the thoracic imaging findings in these patients and may even allow tailoring of additional diagnostic studies and presumptive therapy.In addition to a number of commonly encountered etiologies for an increased permeability pattern on chest radiography, several conditions primarily characterized by interstitial and/or alveolar inflammation or pulmonary hemorrhage should be considered, among them acute eosinophilic pneumonia. Acute eosinophilic pneumonia often presents in previously healthy patients without a prior history of asthma, usually without peripheral blood eosinophilia, and produces respiratory failure. Thoracic imaging studies show rapidly progressing multifocal bilateral air-space consolidation without features of hydrostatic pulmonary edema. Bronchoscopy is the diagnostic procedure of choice and will show significant pulmonary eosinophilia on bronchoalveolar lavage. Corticosteroid therapy causes clearing of the pulmonary findings and rapid resolution of respiratory failure. Relapse is not a feature of acute eosinophilic pneumonia.

Original languageEnglish (US)
Pages (from-to)300-303
Number of pages4
JournalClinical Pulmonary Medicine
Issue number5
StatePublished - Sep 2008


  • Chest radiography
  • Computed tomography
  • Eosinophilic pneumonia
  • Peripheral

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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