Granulomatosis with polyangiitis

Case contributed by Bruno Di Muzio
Diagnosis almost certain

Presentation

Hemoptysis.

Patient Data

Age: 50 years
Gender: Male

Chest

ct
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Axial HRCT
inspiration
This study is a stack
Axial
non-contrast
This study is a stack
Axial lung
window
This study is a stack
Coronal
lung window
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Sagittal
lung window
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Info

There are bilateral pulmonary nodules measuring up to 2.5 cm in diameter, with one of them, at the superior segment of the left lower lobe, showing cavitation. Biapical pleuro-parenchymal scarring. Lungs and pleural spaces are otherwise clear. Airways are normal. No thoracic lymphadenopathy. Hepatic steatosis partially imaged. 

Chest (1 year later)

ct
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Info

The previously documented pulmonary nodules have improved and mostly resolved. No new nodules. 

Chest (3 years later)

ct
This study is a stack
Axial HRCT
inspiration
This study is a stack
Axial lung
window
This study is a stack
Coronal
lung window
This study is a stack
Sagittal
lung window
This study is a stack
Axial
non-contrast
Download
Info

New RUL solid nodule measuring 5 mm and left lower lobe superior segment cavitation nodule measuring 1.5 cm. 

Case Discussion

This case illustrates the typical pattern of recurrent/relapsing cavitated pulmonary nodules seen in granulomatosis with polyangiitis. This patient has a confirmed diagnosis and has been in chronic treatment. 

Differential for cavitated pulmonary nodules include: 

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