Discussion
Diagnosis With Brief Discussion
- Diagnosis
- IgG4-related disease
- Radiologic Findings
- CT scans show thickening of the bronchial wall and peribronchial consolidation in the right lung. Hilar and right inferior interlobar LN enlargement is also noted. PET/CT scan reveals hypermetabolic peribronchial LNs and consolidation in the right lung.
Right lower lobe wedge resection was performed and pathology confirmed IgG4-related disease.
- Brief Review
- IgG4-related disease is characterized by extensive IgG4-positive lymphoplasmacytic infiltration of various organs. IgG4-related disease involving thoracic organs has been reported to manifest as interstitial pneumonia, inflammatory pseudotumor, mediastinal fibrosis, pleuritis and bronchial inflammation.
Based on computed tomography features, IgG4-related disease can be categorized into four subtypes: solid nodular, round-shaped ground-glass opacity, alveolar interstitial and bronchovascular.
Common radiologic findings include mediastinal lymphadenopathy and thickening of the perilymphatic interstitium, with or without subpleural and/or peribronchovascular consolidation. Major differential diagnoses include organizing pneumonia (bronchiolitis obliterans organizing pneumonia), lung cancer, malignant lymphoma and lymphoproliferative disorders such as multicentric Castleman disease.
- Please refer to
Case 723, Case 774, -
- References
- 1. D. Inoue, Y. Zen, H. Abo,T. Gabata, H. Demachi, T. Kobayashi, et al. Immunoglobulin G4 related lung disease: CT findings with pathologic correlations. Radiology 2009; 251: 260-270.
2. J.H. Ryu, H. Sekiguchi and E.S. Yi Pulmonary manifestations of immunoglobulin G4-related sclerosing disease. Eur Respir J 2012; 39: 180–186
3. S.Matsui, A. Hebisawa, F. Sakai, H. Yamamoto, Y. Terasaki, Y. Kurihara, et al. Immunoglobulin G4-related lung disease: Clinicoradiological and pathological features. Respirology 2013; 18, 480–487
- Keywords
- Lung, Non-infectious inflammation, Immune,