Thoracic manifestation of Wegener's granulomatosis: Computed tomography findings and analysis of misdiagnosis

Abstract

The aim of the present study was to investigate the computed tomography (CT) manifestations of Wegener granulomatosis (WG) in the chest and potential reasons for misdiagnosis. Conventional CT scans and clinical data of 45 patients with WG were retrospectively analyzed. Patients typically presented with multiple system involvement, primarily in the upper and lower respiratory tract. The incidence of thoracic involvement was 75.56% (34/45). Radiographic features were varied between cases in the present study, with the most common features being numerous cavitary nodules and masses in the lungs. Cavitations were usually irregular, with uneven wall thickness, partial centrality, fuzzy inner edges and piecemeal necrosis. These results indicate that WG typically has multiple system involvement, with the chest being most prominent. Multiple variable-sized cavitary nodules with irregular edges and piecemeal necrosis were the most notable features revealed using CT scanning; however, in order to give a definitive diagnosis, biopsies should be performed.

Investigation of the frequency and clinical manifestations of Wegener vasculitis among other vasculitis patients in rheumatology ward of Vali-asr hospital during the past 10 years

“…In the current study, it was shown that increased thickness of the paranasal sinuses, pulmonary cavity, and pulmonary nodules are the most common radiological findings in GPA patients. Consistent with these results, Jiakai Li et al, in a study of 45 GPA patients, showed that cavitation was the most common radiological finding in those patients [11]. A recent study of 225 GPA cases showed that the presence of solid and pulmonary cavity nodules was associated with poorer prognosis in those patients [12].…”

A Case of Seronegative Pulmonary-renal Syndrome: Diagnostic and Therapeutic Challenge

“…Hemoptysis is the most common but not specific clinical manifestation of DAH [10] was present in our case. The CT of pulmonary involvement in AAV was manifested with multiple nodules of variable size randomly distributed throughout the lungs, with airspace consolidation and ground-glass opacities, while in anti-GBM antibody disease was ground-glass and consolidated opacities that progress to a reticular "crazy paving" pattern over a few weeks [11]. In our case, the presence of nodules was more indicative of AAV, but their non-cavitation and radiographic resolution during follow-up were more in the direction of anti-GBM antibody disease.…”

Noninfectious Granulomatous Diseases of the Chest

“…Diagnosis of GPA can be made if (a) histologic results are compatible with the guidelines of the Chapel Hill Consensus Conference for GPA; (b) histologic results are compatible with microscopic polyangiitis, and the patient has surrogate markers of GPA; or (c) there are no histologic results, but there are positive surrogate markers and serologic results for antiprotease 3, myeloperoxidase, and antineutrophil cytoplasmic antibodies (ANCA). As with EGPA, CT is the mainstay in evaluating patients with GPA who have suspected thoracic involvement (17).…”

“…The incidence of thoracic involvement in GPA is up to 75% (17). Nodules or masses with or without central cavitation are the most frequent finding in GPA (Fig 5).…”