Imaging of Pulmonary Vasculitis

Abstract

The presence of pulmonary vasculitis can be suggested by a clinical presentation that includes diffuse pulmonary hemorrhage, acute glomerulonephritis, chronic refractory sinusitis or rhinorrhea, imaging findings of nodules or cavities, mononeuritis multiplex, multisystemic disease, and palpable purpura. Serologic tests, including the use of cytoplasmic antineutrophil cytoplasmic antibody (ANCA) and perinuclear ANCA, are performed for the differential diagnosis of the diseases. A positive cytoplasmic ANCA test result is specific enough to make a diagnosis of ANCA-associated granulomatous vasculitis if the clinical features are typical. Perinuclear ANCA positivity raises the possibility of Churg-Strauss syndrome or microscopic polyangiitis. Imaging findings of pulmonary vasculitis are diverse and often poorly specific. The use of a pattern-based approach to the imaging findings may help narrow the differential diagnosis of various pulmonary vasculitides. Integration of clinical, laboratory, and imaging findings is mandatory for making a reasonably specific diagnosis.

Review article: Thoracic involvement in systemic primary vasculitis: radiological patterns and follow-up

“…Although overlapping patterns are very common, characteristic imaging features and their associations can help distinguish between diseases (6)(7)(8). In this process, the knowledge of the clinical background of the patient is crucial.…”

Henoch-Schönlein Purpura

“…Pulmonary involvement is rare and has been reported in the literature as isolated cases (Jennette and Falk 1997;Nadrous et al 2004). It occurs more often in adults and commonly manifests as diffuse alveolar hemorrhage (Castañer et al 2010;Chung et al 2010). …”

Severe cardiovascular involvement in Hughes-Stovin syndrome

“…[1][2][3] Typically young men between the second and fourth decades are affected. [4][5][6][7] The prevalence of the disease worldwide is less than 1:1,000,000, [4] making it extremely rare. The clinical symptoms are recurrent fever, chills, peripheral venous thrombosis, multiple pulmonary artery aneurysms, cough, fatigue, dyspnea, chest pain and hemoptysis.…”

“…The clinical symptoms are recurrent fever, chills, peripheral venous thrombosis, multiple pulmonary artery aneurysms, cough, fatigue, dyspnea, chest pain and hemoptysis. [5][6][7] Further, nearly all patients with Behçet's disease present oral mucocutaneous ulcerations in the form of aphthous ulcers. Additionally, patients may present with genital ulcers, erythema nodosum, cutaneous pustular vasculitis or uveitis.…”