Acute eosinophilic pneumonia on radiography and CT

These images were obtained from a 42-year-old man with progressive dyspnea over one month; acute eosinophilic pneumonia was diagnosed based on the clinical presentation, a bronchoalveolar lavage showing 51 percent eosinophils, and response to therapy. An anteroposterior radiograph (A) shows patchy opacities predominantly involving the lower lobes, middle lobe, and lingual (arrows). This pattern is unlike heart failure since the left atrium is not enlarged, there is no vascular redistribution, and the opacities are diffuse in nature and not perihilar. A CT with coronal reconstruction (B) shows patchy opacities involving all segments of the lung (arrows). An axial CT at the level of the carina (C) shows a combination of ground glass and consolidative opacities in the anterior segments of both upper lobes (arrows). A CT scan through the mid chest (D) shows pulmonary opacities centered along thickened broncho-vascular bundles (arrows).