Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients

Abstract

Our objective was to describe the CT findings of thoracic Wegener's granulomatosis. At presentation, both conventional and thinsection CT scans were available in 30 patients with Wegener's granulomatosis. Serial CT scans (range of intervals: 1-25 months, mean 4.5 months) were available in 20 patients. The initial and follow-up CT scans were analyzed retrospectively by two observers in terms of pattern and extent of parenchymal and airway lesions. Positive CT findings were seen in 29 of 30 (97%) patients at initial presentation. The most common pattern was nodules or masses seen in 27 of 30 (90%) patients. They were multiple in 23 of 27 (85%) patients, bilateral in 18 (67%), subpleural in 24 (89%), and peribronchovascular in 11 (41%) in distribution. Bronchial wall thickening in the segmental or subsegmental bronchi was seen in 22 (73%) patients. Large airways were also abnormal in 9 (30%) patients. Patchy areas of consolidation and ground-glass opacity were seen in 7 (23%) patients, respectively. In 17 of 20 (85%) patients in whom follow-up CT scans were available, the parenchymal or airway lesion showed complete or partial improvement with treatment. The CT findings of Wegener's granulomatosis, although multiple and variable, consist mainly of bilateral subpleural or peribronchovascular nodules or masses and bronchial wall thickening in the segmental or subsegmental bronchi. Parenchymal and airway lesions improve with treatment in most patients.

A Case of Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) Presenting with Marked Inflamed Tracheobronchial Mucosa

“…On the other hand, airway involvement in GPA does not show typical radiographic pattern. In large airways, these findings may consist of focal or elongated segments of bronchial stenosis and intraluminal soft tissue mass or bronchial thickening with or without lobar or segmental atelectasis [4]. Bronchiectasis and peribronchial thickening in small airways were reported in approximately 40% of GPA [5].…”

Approach to Peribronchovascular Disease on CT

“…8). 71 The halo sign is reported in the series by Lee et al in 15%. 71 Adenopathy is less common, on the order of 20%.…”

“…71 The halo sign is reported in the series by Lee et al in 15%. 71 Adenopathy is less common, on the order of 20%. 68 Tests for cytoplasmic ANCA are highly positive on the order of 90% and have a high positive predictive value for GPA.…”

Distinguishing Wegener's granulomatosis from necrotizing community acquired pneumonia: A case report and comparison of radiographic findings

“…The patient is this report was unusual in that she presented with a large, solitary cavitary lesion sans nodular changes whereas most cavitary lesions in WG typically occur in the presence of nodular disease and are multifocal. 3–5 Cavitary changes may be occasionally found in complicated CAP. 6–9 In addition, cavitary necrosis in CAP is regularly accompanied by pleural effusions while pleural effusions are uncommon in pediatric WG and should be indicative of another process.…”

“…6–9 In addition, cavitary necrosis in CAP is regularly accompanied by pleural effusions while pleural effusions are uncommon in pediatric WG and should be indicative of another process. 3–9 Perhaps the most important clinical observation that can be made to differentiate WG from complicated CAP is that almost all patients with necrotizing pneumonia respond to aggressive medical and surgical therapy. 10 …”