Eosinophilic granulomatosis with polyangiitis

Case contributed by Dr Fabien Ho


Past history of asthma and sinonasal polyps. Non-smoker. Known stables pulmonary nodules without PET uptake for 3 years. Subacute dyspnea. Peripheral eosinophilia on bloodwork.

Patient Data

Age: 60 years
Gender: Male

Peripheral consolidation / ground glass opacity and solid centrilobular nodules (non cavitated).

3 months later, after antibiotics treatment


Persistent peripheral consolidation / ground glass opacity and solid centrilobular nodules (non cavitated), except the left part which underwent slight changes with now a moderate pleural effusion. There is no obvious migratory consolidation/GGO.

Case Discussion

Chronic consolidation which does persist after standard antibiotics must raise suspicions for inflammatory disease, or lymphoma or bronchioloalveolar carcinoma.

In this patient, the peripheral consolidation/GGO pattern had favored the diagnosis towards chronic eosinophilic lung. However, the additional nodules indicated a likely associated granulomatosis, hence, with all clinical (asthma, sinonasal polyps) and lab elements (peripheral eosinophilia) the most likely diagnosis was eosinophilic granulomatosis with polyangiitis (previously known as Churg-Strauss syndrome).

Organized pneumonia was considered unlikely: lack of migratory elements, no reversed halo sign.  Granulomatosis with polyangiitis (Wegner granulomatosis) usually features cavitated nodules and the consolidation does not have a peripheral pattern.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.