Diffuse alveolar hemorrhage - Goodpasture syndrome

Case contributed by Jeffrey Lai
Diagnosis almost certain



Patient Data

Age: 19
Gender: Female

The tip of the CVC is projecting over the SVC. Minor hazy airspace opacification in the right mid and lower zones. The pleural space are clear. Cardiomediastinal contours are normal.

Non contrast scans were performed due to impaired renal function.

There is diffuse patchy ground-glass opacity within both lungs predominately within the upper lobes and apical lower lobes with relative sparing of the bases. Compared with the prior examination from a month ago this has improved within the right lung but is more confluent within the left lung, with infiltrates seen both centrally and peripherally. No interlobular septal thickening or nodules. The airways are normal. Pleural spaces are clear.

No pericardial effusion. No thoracic lymphadenopathy. No suspicious osseous lesions.

Conclusion: Diffuse alveolar infiltrates predominately within the upper lobes and apical lower lobes appear more confluent on the left and improved on the right compared with one month ago. Given the patient's history of Goodpasture syndrome, appearances are in keeping with pulmonary hemorrhage.

Case Discussion

This patient has had confirmed diagnosis of Goodpasture syndrome, which is a disease related to anti-GBM autoantibodies causing pulmonary hemorrhage and glomerulonephritis.

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