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Weekly Chest CasesArchive of Old Cases

Case No : 606 Date 2009-06-08

  • Courtesy of Jae Kyo Lee / Yeungnam University Medical Center
  • Age/Sex 56 / M
  • Chief ComplaintC/C : aggravated dyspnea for 3 days, Lab findings : CBC - 6450/7.0/241K/ul(WBC/Hct/Plt), ANCA (+)
  • Figure 1
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March 29, 2003

Diagnosis With Brief Discussion

Diagnosis
Microscopic Polyangiitis
Radiologic Findings
Brief Review
Microscopic polyangiitis results in systemic necrotizing small vessel vasculitis. Although the histology is similar to classic PAN(polyarteritis nodosa), involvement of arterioles, venules, and capillaries distinguishes it from PAN. Also, ANCA(usually P-ANCA) is present in 80%; ANCA is rare in PAN.
MIcroscopic polyangiitis typically occurs in middle-aged adults; men are more commonly involved. Glomerulonephritis develops in 90% of patients, and other organs may be involved. Pulmonary hemorrhage related to capillaritis occurs in 25%, associated with dyspnea and hemoptysis. Radiographic findings are typical of pulmonary hemorrhage. Pleural effusion and pulmonary edema are see in about 10%, likely related to renal disease. Progression to pulmonary fibrosis is rare. Treatment with cyclophosphamide and steroids often results in remission.
References
1. Savage CO, Winearls CG, Evans DJ et al. Microscopic polyarteritis:presentation, pathology and prognosis. GJ Med 1985;56:467-483.
Keywords
Lung, Vasculitis, Microscopic polyangitis,

No. of Applicants : 92

▶ Correct Answer : 17/92,  18.5%
  • - Osaka University , Japan Osamu Honda
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - National Taiwan University Hospital, YL branch , Taiwan Chin-Chung Shu
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - G.R.M.C. GWALIOR , India anup gupta
  • - CHRU lille , France manuel toledano
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - CH Sud Rnion , Reunion jean-baptiste Noel
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
  • - Hopital du SacrCoeur , Canada Abraham Bohadana
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - CHUV, Lausanne , Switzerland Andrea Ojanguren
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
▶ Correct Answer as Differential Diagnosis : 20/92,  21.7%
  • - WARABI CITY HOSPITAL , Japan YASUO OKUBO
  • - Assam medical college , India Karunakaran M
  • - hospital Sao Paulo , Brazil israel missrie
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - CHU caen , France nicolas gautier
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - Mackay Memorial Hospital , Taiwan Sheng-Yeh Shen
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - Seoul Nationial University Bundang Hospital , Korea (South) Kyoung Jin Oh
  • - clinique de rochefort , France viviane pages
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - NASA SCANS , India RAKESH BHATIA
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
▶ Semi-Correct Answer : 20/92,  21.7%
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - NTUH , Taiwan Kuei-pin Chung
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Saga University , Japan Ryoko Egashira
  • - Paramount Diagnostic & Research Centre , India Mahavir Swami
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - tanta university-egypt , Egypt abdou abdou
  • - The Armed Forces Daegu Hospital , Korea (South) Hyungwoo Oh
  • - kims,narkatpally , India k bhaskar
  • - chp st martin , France Mariotte benoit
  • - NOUR EL-ISLAM RADIOLOGY CENTER , Egypt Elsayed Mousa
  • - CHU Grenoble , France Fabrice Bing
  • - IRSA , France jean BIGOT
  • - DCA, , India Rajesh Gothi
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - Kangnam Sacred Heart Hospital , Korea (South) Jaewon Kim
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