Granulomatosis with polyangiitis is a systemic necrotizing vasculitis that affects the small- and medium-sized blood vessels. The diagnosis can be challenging since the clinical and imaging findings have similarities with infection, and malignancy. Serologic and histopathological investigations often help confirm the diagnosis. However, this can be falsely reassuring. We present a unique case of the coexistence of vasculitis and squamous cell carcinoma in the same cavitating lung mass. The case highlights the importance of recognizing changes in disease behaviour early to allow for timely management.
Dynamic contrast-enhanced magnetic resonance lymphangiography is a radiation-free, high spatial resolution technique which is increasingly used to evaluate thoracic lymphatic disorders and for pre-procedural planning. DCE has the added advantage of allowing dynamic real-time evaluation of lymphatic flow. It can be employed to investigate commonly encountered clinical situations such as recurrent pleural effusions following trauma, thoracic duct injury after thoracic surgery, and exclude diseases and congenital malformations of the thoracic lymphatic system. The imaging procedure and protocol are detailed in this case series to highlight the application of dynamic contrast-enhanced magnetic resonance lymphangiography in everyday practice and its importance to guide surgical planning.
Die Granulomatose mit Polyangiitis ist eine systemische nekrotisierende Vaskulitis, von der kleine bis mittlere Blutgefäße betroffen sind. Die Diagnosestellung kann dadurch erschwert werden, dass die klinischen und radiologischen Befunde Ähnlichkeiten mit Infektionen und malignen Erkrankungen aufweisen. Serologische und histopathologische Untersuchungen können bei der Sicherung der Diagnose sehr hilfreich sein, können aber auch falsche Sicherheit erzeugen. Wir stellen einen einzigartigen Fall des gleichzeitigen Bestehens einer Vaskulitis und eines Plattenepithelkarzinoms in derselben kavernösen pulmonalen Raumforderung vor. Der Fall unterstreicht, wie wichtig es ist, Auffälligkeiten im Krankheitsverlauf früh zu bemerken, um rechtzeitig handeln zu können.
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