Sinonasal Wegener's granulomatosis: CT characteristics

Abstract

Wegener's granulomatosis (WG) is a severe and potentially lethal granulomatosis. Even though no specific radiological criteria exist, CT may suggest the correct diagnosis at an early stage. Recent improvement in the prognosis is related to earlier diagnosis, allowing the initiation of efficient and specific treatment before any severe complications occur. We reviewed a series of WG cases in order to establish the CT diagnostic criteria.

Imaging Features of Granulomatosis with Polyangiitis (Wegener’s)

“…Now, CT is a superior imaging technique to evaluate bone abnormalities (Benoudiba et al 2003;Lohrmann et al 2006). Therefore, a CT scan is performed without contrast agent, using a bone filter, with axial, coronal, and sagittal reformatting.…”

“…Subsequent bone deposition is due to a chronic periostitis caused by chronic granulomatous and vasculitic involvement of the sinus mucosa and the periosteum (Yang et al 2001;Benoudiba et al 2003;Lohrmann et al 2006). Other mechanisms have been suggested, such as chronic bacterial periostitis due to S. aureus or the complications of prior surgical manipulations.…”

“…Other mechanisms have been suggested, such as chronic bacterial periostitis due to S. aureus or the complications of prior surgical manipulations. However, those hypotheses are inconstant among patients with sinonasal lesions (Benoudiba et al 2003).…”

“…The involvement of the upper respiratory tract is encountered in 70% of patients at the beginning of the disease, but clinical onset is nonspecific (Benoudiba et al 2003). The nasal fossa and the nasal septum are first involved, followed by lesions of the sinuses.…”

Kraniale Manifestation des Morbus Wegener: Aktueller Stand der Diagnostik

“…Gerade diese Befundkonstellation macht die Diagnose der WG gegenüber der Sinusitis maxillaris und der primären oder erworbenen Sinushypoplasie wahrscheinlich. Kräftigere Knochen wie die ventrale und dorsolaterale Wand des Sinus maxillaris, aber auch der Orbitaboden, das Sphenoid und der Alveolarfortsatz zeigen dagegen ein Nebeneinander von Demineralisation, erosiven und sklerosierenden Knochenveränderungen begleitet von einer Weichteilinfiltration der angrenzenden Fettlamellen [13,14].…”