J Korean Soc Radiol.  2017 Sep;77(3):177-182. 10.3348/jksr.2017.77.3.177.

A Case of Pulmonary Granulomatosis with Polyangiitis Mimicking Septic Pneumonia Resulting from Middle Ear Infection

• Lee S
• Chong S
• Cha MJ
• Kim MK

• KMID: 2405732
• DOI: http://doi.org/10.3348/jksr.2017.77.3.177

Abstract

Granulomatosis with polyangiitis (GPA) is a multisystemic disease characterized by necrotizing granulomatous vasculitis, which histopathologically presents as vasculitis and granulomas with multinucleated giant cells. In pulmonary GPA, pulmonary cavity is a commonly observed imaging pattern although nodule and consolidation are the most common imaging findings. This cavitation follows a fluid-filled space within a pulmonary consolidation, a mass, or a nodule through the expulsion or drainage of a low-attenuation necrotic part of the lesion via the bronchial tree. However, in previous CT studies of pulmonary GPA, most cavitations appear as gas-filled spaces rather than accompanying necrotic fluid-attenuation areas. Therefore, we report a case of pulmonary GPA that presented with consolidations and nodules accompanied by a central low-attenuation area on CT, which mimicked septic pneumonia.

MeSH Terms

Drainage
Ear, Middle*
Giant Cells
Granuloma
Granulomatosis with Polyangiitis*
Lung
Pneumonia*
Trees
Vasculitis

Figure

• 

  Fig. 1 A 31-year-old woman with pulmonary granulomatosis with polyangiitis mimicking septic pneumonia resulting from middle ear infection. A. Chest radiograph shows multifocal consolidations in both upper and mid lung zones (arrows). B. Axial lung window image of high-resolution computed tomography shows subsegmental and lobular consolidations surrounded by ground-glass opacity in both upper lobes (arrows). C. Coronal mediastinal window images of contrast enhanced chest CT scan show central low-attenuation portions (presumably necrotic changes) within the consolidations in both upper and right lower lobes (arrows). D. Photomicrographs of the biopsy specimen show severe necrotizing inflammation around the vessels (arrow) and granulomatous inflammation with multinucleated giant cells (arrowheads) (hematoxylin and eosin, × 200). E. Chest radiograph obtained on the 5th hospital day shows that the consolidations have increased in their extent in both lungs and are surrounded by ground-glass opacity in the right lung (arrows). F. Chest radiograph taken 8 days after immunosuppressive therapy reveals that the consolidation with surrounding ground-glass opacity has decreased in its extent and changed into irregular thick walled cavitary lesions in both lungs (arrows).

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