대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1299 Date 2022-09-13

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  • Courtesy of Geewon Lee, Yeon Joo Jeong, Minhee Hwang, Ji Won Lee / Pusan National University Hospital
  • Age/Sex 66 / M
  • Chief ComplaintCough and sputum for 1 month, headache for 1 year
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Granulomatosis with polyangiitis
Radiologic Findings
Fig 1. Chest PA shows a cavity mass in the right apex and multiple masses at both lower lobes.
Fig 2-4. Axial chest CT scans with contrast enhancement demonstrate a lobulated, cavity mass at the right apex and central necrotic masses at LUL lingular segment and RML.
Fig 5. PET-CT scan with some misregistration demonstrates a hypermetabolic mass (SUVmax 7.4) with a central photon defect.

PCNB was performed for the LUL mass and the biopsy specimen showed abscess. Thereafter, wedge resection was performed and the biopsy revealed necrotizing granulomatous inflammation and necrotizing vasculitis.
Brief Review
Wegener granulomatosis is an uncommon necrotizing vasculitis that classically manifests as a clinical triad consisting of upper and lower airway involvement and glomerulonephritis. Common pulmonary radiologic findings include waxing and waning nodules, masses, ground-glass opacities, and consolidation. Airway involvement is usually characterized by circumferential tracheobronchial thickening, which can be smooth or nodular. Pleural effusions are the most common manifestation of pleural disease and can result from primary involvement or be 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. CT is the imaging modality of choice for diagnosis, surveillance, and follow-up in patients with Wegener granulomatosis.
References
1. Felipe Martinez, Jonathan H. Chung1, Subba R. Digumarthy, Jeffrey P. Kanne, Gerald F. Abbott, Jo-Anne O. Shepard, Eugene J. Mark, Amita Sharma. Common and Uncommon Manifestations of Wegener Granulomatosis at Chest CT: Radiologic-Pathologic Correlation. Radiographics 2012, 32(1):51-69
Keywords
Granulomatosis with polyangiitis (GPA),

No. of Applicants : 74

▶ Correct Answer : 35/74,  47.3%
  • - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
  • - , Japan HIROAKI ARAKAWA
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - , Japan KYOKO NAGAI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Osaka University , Japan AKINORI HATA
  • - Other , Korea (South) HYEON IL CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yamanashi Prefectural Hospital , Japan HIROAKI WATANABE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - Other , Korea (South) KYU-CHONG LEE
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 17/74,  23.0%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - , Japan YUKIKO USUI
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Holy Family Hospital , India RAJESH GOTHI
  • - Others , India PURUSHOTHAMA RAO TUMMALA
  • - DAYA General Hospital,Thrissur,Kerala , India T K RAVEENDRAN
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 2/74,  2.7%
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Other , Korea (South) SEONG WON JANG
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