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Weekly Chest CasesCases by Disease Category

Case No : 1228 Date 2021-05-03

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  • Courtesy of Min Kyung Jung, Jeong Min Ko, Hyun Jin Park / St. Vincent
  • Age/Sex 58 / M
  • Chief ComplaintEye pain, Maxillary Td (+)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Granulomatosis with polyangiitis (formerly, Wegener's granulomatosis)
Radiologic Findings
Fig. 1. Chest radiograph showing multifocal nodular increased opacities in both upper lung fields.
Figs. 2
Brief Review
Granulomatosis with polyangiitis is an uncommon necrotizing vasculitis that classically manifests as a clinical triad consisting of upper airway involvement, lower airway involvement, and glomerulonephritis. Because thoracic involvement is often predominant, chest radiographic findings are often the first to suggest the diagnosis. Common pulmonary radiologic findings include waxing and waning nodules, masses, ground-glass opacities, and consolidation. Airway involvement is usually indicated by circumferential tracheobronchial thickening, which can be smooth or nodular. Pleural effusion is the most common manifestation of pleural disease and can result from primary involvement or occur secondary to renal failure. Mediastinal lymphadenopathy is a nonspecific finding and is usually reactive. Uncommon thoracic radiologic manifestations include involvement of the heart and great vessels.
Ocular and orbital manifestations are common in almost half of the patients with granulomatosis with polyangiitis, affecting every structure of the eye, from the eyelid and orbit to the retina, choroid, and optic nerve, with a wide range of severity.
Elevation of serum cytoplasmic ANCA (c-ANCA) titers, usually directed toward proteinase 3 and myeloperoxidase (found in neutrophils), occurs in up to 90% of patients with active Wegener granulomatosis. The correlation between c-ANCA and Wegener granulomatosis has been well established. Although c-ANCA testing can aid in the diagnosis, a positive result is not conclusive. Negative c-ANCA test results are not sufficient to exclude the diagnosis, and biopsy remains the standard diagnostic method.
References
Common and Uncommon Manifestations of Wegener Granulomatosis at Chest CT: Radiologic-Pathologic Correlation RadioGraphics 2012; 32:51
Please refer to
Case 1078 Case 1067 Case 1026 Case 763 Case 722 Case 678
Keywords

No. of Applicants : 92

▶ Correct Answer : 41/92,  44.6%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Other , Korea (South) HYEJIN YANG
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , Korea (South) JIN YOUNG LEE
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - HHS , Canada S LEE
  • - Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
  • - Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Soonchunhyang University Hospital Bucheon , Korea (South) SEONGHWAN BYUN
  • - Other , Korea (South) MINSU KIM
  • - Kyeongpook National University Hospital , Korea (South) MIRAN KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) SEOYUN CHOI
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Tokyo Metropolitan Bokutoh Hospital , Japan TOMOKI WADA
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 24/92,  26.1%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - CHCB , France LE GUEN RAPHAEL
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Other , Korea (South) SEONGSU KANG
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - , Japan KANAE TAKAHASHI
  • - , Korea (South) EUNJIN LEE
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - , Japan HIROAKI ARAKAWA
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - TB centre kasaragod. , India rikhy krishnan
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - , Japan TOMOKI IMOKAWA
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - algeria , Algeria ZAKARIA CHERAGA
▶ Semi-Correct Answer : 4/92,  4.3%
  • - , Korea (South) HYEYOUNG CHOI
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Qatif Central Hospital , Saudi Arabia HANI MAKKY ALSALAM
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
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Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

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