Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Eosinophilic granulomatosis with polyangitis (EGPA)
- Radiologic Findings
- Fig. 1. Chest posteroanterior radiograph showing subtle ground-glass opacities in both lower lobes.
Figs. 2 and 3. Chest computed tomography (CT) scan showing bronchial wall thickening, centrilobular nodules, ground-glass opacities, and interlobular septal thickening in both lungs, predominantly in the lower lobes.
Fig. 4. Additional chest CT findings showing a small amount of bilateral pleural effusion and enlarged lymph nodes in both hila.
Fig. 5. Pharyngeal CT scan showing fluid retention and wall thickening in both maxillary sinuses, suggestive of sinusitis.
- Brief Review
- A 46-year-old man visited our hospital because of nasal obstruction persisting for 1 week. He has had asthma for several years. Leukocytosis and eosinophilia were observed in peripheral blood samples. He was positive for the anti-myeloperoxidase antibody (perinuclear anti-neutrophil cytoplasmic antibody [ANCA]), but negative for the anti-proteinase 3 antibody (cytoplasmic ANCA), IgE M3 (for Aspergillus), and IgE P4 (for Anisakis). An eosinophil level of 65% was found on differential cell count of bronchoalveolar lavage fluid. Microscopic hematuria was detected in urine. The patient was diagnosed with glomerulonephritis with eosinophilic infiltration on renal biopsy.
Eosinophilic granulomatosis with polyangiitis (previously known as Churg-Strauss syndrome) has been defined as the presence of eosinophil‐rich and granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small- to medium-sized vessels. It is associated with asthma and eosinophilia. ANCA is more frequent in the presence of glomerulonephritis (Revised International Chapel Hill Consensus Conference, 2012).
Eosinophilic granulomatosis with polyangiitis is characterized by systemic vasculitis involving multiple organs, with upper airway disease and pulmonary abnormalities being the most common manifestations. The most common radiographic findings are transient, patchy, and nonsegmental opacities. The common abnormalities on high-resolution computed tomography are small nodules, ground-glass opacities, bronchial wall thickening or dilatation, consolidation, interlobular septal thickening, and mosaic perfusion.
- Please refer to
Case 523, -
- References
- 1) Imaging of Pulmonary Vasculitis Radiology 2010 255:2, 322-341
2) Respiratory manifestations of eosinophilic granulomatosis with polyangiitis (Churg–Strauss) European Respiratory Journal 2016, 48 (5) 1429-1441
3) Eosinophilic granulomatosis with polyangiitis (Churg–Strauss): state of the art. Allergy 2013; 68: 261– 273.
- Keywords