Thoraco-pulmonary manifestations of Whipple disease are uncommon and present in the late stages of the disease.
Lung involvement is seen in 35-60% of patients with gastrointestinal whipple disease.
Majority of patients present with non-specific pulmonary and general symptoms like a chronic non-productive cough, pleuritic chest pain, dyspnea, progressive weight loss, anorexia, malaise, arthralgia and intermittent fever.
Grossly there are areas of consolidation around bronchovascular channels which appear similar to sarcoidosis. Microscopically there are periodic acid-Schiff positive inclusion bodies in the macrophages within the lesion.
Various patterns can be observed in pulmonary Whipple disease which may include:
- diffuse or focal pulmonary infiltrates
- basal lung opacities
- nodular lesions
- pleural adhesions
- pleural effusion
CT may reveal basal infiltrates, soft tissue nodules, mediastinal and hilar lymphadenopathy.
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