Peripheral pulmonary infiltrates + peripheral eosinophilia, suspected eosinophilic pneumonia
Recommended: CT Chest with IV contrast is the preferred imaging study for peripheral pulmonary infiltrates + peripheral eosinophilia, suspected eosinophilic pneumonia. Acute (AEP), chronic (CEP), or drug/parasite-induced.
Recommended study
CT Chest with IV contrast
Acute (AEP), chronic (CEP), or drug/parasite-induced. Peripheral 'reverse pulmonary edema' pattern.
If the default doesn't apply
Diagnostic confirmation
BAL with eosinophil count + biopsy if needed
No contrast
Watch-outs
Drug history is critical
Daptomycin, nitrofurantoin, NSAIDs, sulfasalazine, antidepressants are common offenders.
Pearls
- Chronic EP: 'photographic negative of pulmonary edema' — peripheral, upper-lobe predominant.
- Acute EP: bilateral diffuse ground-glass + interlobular septal thickening + effusions.
- Steroid-responsive; relapse common in CEP.