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Weekly Chest CasesArchive of Old Cases

Case No : 678 Date 2010-10-26

  • Courtesy of Giyoung Seo, Jae Seung Seo, Semin Chong / Chung-Ang University Hospital
  • Age/Sex 68 / M
  • Chief ComplaintMyalgia for 40 days, fever, chilling sensation, weight loss
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Wegener's granulomatosis
Radiologic Findings
Figure 1. Chest radiograph shows multiple patchy nodular opacities in both lungs.
Figure 2. Water`s view shows mucoperiosteal thickening in both maxillary sinuses.
Figure 3-5. Chest CT scan shows multiple, irregular or ill-defined nodules scattered in both lungs with peribronchovascular or centrilobular distribution pattern.
Brief Review
In this case, thoracoscopic wedge resection in the left lower lobe was done and the specimen revealed capillaritis and fibrinoid necrosis with cicatrical change in arterioles and venules. Laboratory test show all positive for c-ANCA ( MPO Ab) and p-ANCA ( PR3-Ab ). Wegener’s granulomatosis was diagnosed in consideration of his radiologic, pathologic and clinical findings. After steroid and cytoxan treatment, three months follow up chest radiograph (not shown) showed disappearance of the nodular opacities scattered in both lungs.
References
Please refer to case 90, 104.
Keywords
Lung, Vasculitis, ANCA associated vasculitis,

No. of Applicants : 86

▶ Correct Answer : 49/86,  57.0%
  • - McGill University , Canada Ben Smith
  • - Osaka University , Japan Osamu Honda
  • - University of British Columbia , Canada Amr Ajlan
  • - Okayama University , Japan Akihiro Tada
  • - radiologist, aditya imaging centre , India vivek patel
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - aarthi scans , India abirami mahadevan
  • - Assam Medical college , India samudra borah
  • - Hospital M� de Deus , Brazil Thiago Bento da Silva
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - NDMVP Nashik , India Imran Jindani
  • - KHOO TECK PUAT HOSPITAL , Singapore SUMER SHIKHARE
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Yashoda Superspeciality hospital , India Pravin Mahadevappa
  • - KING KHALID UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Montreal , Canada D J
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - kobe city general hospital , Japan rintaro hashimoto
  • - Saga University , Japan Ryoko Egashira
  • - CHU Notre-Dame Montreal , Canada Fabrice Bing
  • - KUMC ansan , Korea (South) kihwan kim
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - grmc gwalior , India shailesh gupta
  • - G.R. Medical College, Gwalior , India Rajesh Pillai
  • - Chonnam National University Hospital , Korea (South) Daun Lee
  • - CNUH , Korea (South) Seoin Jeong
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - Chonnam university hospital , Korea (South) LEE HYUN
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Bundang CHA hospital , Korea (South) Sojung Kim
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - McGill University Health Center , Canada Alexandre Semionov
  • - KMC,Manipal , India satish maddukuri
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - IRSA Rochefort , France Viviane Pages
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Yonsei University College of Medicine, Severance Hospital , Korea (South) Hyung Jin Rhee
  • - okayama , Japan ryota inai
  • - Shree Diagnostics , India amol jagdale
  • - bmcri , India sanjeev choudri
  • - jobless , France jean-baptiste Noel
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
▶ Correct Answer as Differential Diagnosis : 21/86,  24.4%
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - NTUH , Taiwan Kuei-pin Chung
  • - Kobe City Medical Center General Hospital , Japan Hitomi Nagano
  • - Siirt Devlet Hastanesi , Turkey Armagan Sarac
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - vims bellary , India akhila d
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Doctors Hospital , Bahamas muneesh sharma
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Cairo University , Egypt Mamdouh Eissa
  • - NASA SCANS , India RAKESH BHATIA
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - All India Institute of medical sciences , India Justin Moses
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