143 Wegener Granulomatosis or ANCA-Associated Granulomatous Vasculitis

CASE 143


image Clinical Presentation


72-year-old woman with cough, sinusitis, and renal insufficiency


image Radiologic Findings


PA chest radiograph (Fig. 143.1) demonstrates a right upper lobe mass-like consolidation with associated volume loss. Unenhanced chest CT (lung window) (Figs. 143.2, 143.3, 143.4) shows a peripheral wedge-shaped right upper lobe consolidation and multi-focal peripheral subpleural and angiocentric pulmonary masses and nodules.


image Diagnosis


Wegener Granulomatosis or ANCA-Associated Granulomatous Vasculitis


image Differential Diagnosis


• Multicentric Primary or Secondary Neoplasia


• Multifocal Pneumonia


• Bland or Septic Emboli, Pulmonary Infarcts


• Other Pulmonary Vasculitis


• Cryptogenic Organizing Pneumonia



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Fig. 143.1



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Fig. 143.2




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Fig. 143.3



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Fig. 143.4


image Discussion


Background


The pulmonary vasculitides include several disorders characterized by inflammation of the pulmonary blood vessel walls. The term ANCA-associated granulomatous vasculitis has been proposed to replace the eponymous term Wegener granulomatosis, the most common pulmonary vasculitis. The diagnosis of pulmonary vasculitis requires careful correlation of clinical and imaging findings with the underlying histologic features and the exclusion of infectious granulomatous diseases, many of which often exhibit histologic features of vasculitis.


Etiology


The etiology of pulmonary vasculitis is unknown.


Clinical Findings


ANCA-associated granulomatous vasculitis (Wegener granulomatosis) is a systemic necrotizing vasculitis that commonly affects the lung, with an annual incidence of one case per 100,000 population. Although many organs are affected, classical Wegener granulomatosis

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Jan 14, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on 143 Wegener Granulomatosis or ANCA-Associated Granulomatous Vasculitis
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