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Thoracic Manifestation of Churg-Strauss Syndrome^*

Radiologic and Clinical Findings

Young Hi Choi, MD; Jung-Gi Im, MD; Bu Kyung Han, MD; Jin-Hwan Kim, MD; Kye Young Lee, MD and Na Hye Myoung, MD

^* From the Departments of Radiology (Dr. Choi), Internal Medicine (Dr. Lee), and Pathology (Dr. Myoung), Dankook University College of Medicine, Choongnam, Korea; Department of Radiology (Drs. Im and Han), Seoul National University, College of Medicine, Seoul, Korea; and Department of Radiology (Dr. Kim), Chungnam National University Hospital, Taejon, Korea. Currently at Samsung Medical Center, Seoul, Korea.

Correspondence to: Young Hi Choi, MD, Department of Radiology, Dankook University College of Medicine, 29 Anseodong, Cheonan, Choongnam, 330–715, Korea; e-mail: choiyh{at}anseo.dankook.ac.kr

Study objectives: To describe the radiologic and clinical findings of Churg-Strauss syndrome (CSS) and its thoracic manifestations.

Design: We used retrospective analysis to review and characterize the radiographic, thin-section CT, and clinical findings of CSS.

Patients: The study involved nine patients with CSS. The patients included four men and five women, whose ages ranged from 18 to 60 years (median, 35 years). Thin-section CT scans and chest radiographs were retrospectively analyzed by three radiologists in consensus. Clinical data were obtained by chart review. Histologic samples were available in eight patients.

Results: All patients had a history of asthma averaging 28 months (range, 4 to 72 months) prior to the initial symptom of vasculitis and marked peripheral blood eosinophilia (mean peak count, 8,726/µL; range, 3,000 to 32,000/µL; mean differential count, 41%; range, 19 to 67%). All patients had systemic vasculitis involving the lung and two to four extrapulmonary organs, most commonly the nervous system (n = 8) and skin (n = 7). Chest radiographs showed bilateral nonsegmental consolidation (n = 5), reticulonodular opacities (n = 3), bronchial wall thickening (n = 3), and multiple nodules (n = 1). The most common thin-section CT findings included bilateral ground-glass opacity (n = 9); airspace consolidation (n = 5), predominantly subpleural and surrounded by the ground-glass opacity; centrilobular nodules mostly within the ground-glass opacity (n = 8); bronchial wall thickening (n = 7); and increased vessel caliber (n = 5). Other findings were hyperinflation (n = 4), larger nodules (n = 4), interlobular septal thickening (n = 2), hilar or mediastinal lymph node enlargement (n = 4), pleural effusion (n = 2), and pericardial effusion (n = 2).

Conclusions: In CSS, thoracic organs are invariably involved with additional diverse manifestations. The possibility of CSS should be raised in patients with a history of asthma and hypereosinophilia who present with thin-section CT findings of bilateral subpleural consolidation with lobular distribution, centrilobular nodules (especially within the ground-glass opacity) or multiple nodules, especially in association with bronchial wall thickening.

Key Words: angiitis • asthma • Churg-Strauss syndrome • CT • granulomatosis • hypereosinophilia • lung abnormalities • radiography

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