Presentation
Hemoptysis.
Patient Data
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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.
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The previously documented pulmonary nodules have improved and mostly resolved. No new nodules.
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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:
- cavitating pulmonary metastases
- infection (eg TB, cryptococcosis)
- non-infective granulomas:
- granulomatosis with polyangiitis
- rheumatoid nodules