Polyarteritis nodosa: with pulmonary hemorrhage
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There are confluent ground glass densities within both lungs, predominantly in a central distribution, with sparing of the subpleural lung.
No septal thickening demonstrated. No pleural effusion or lymphadenopathy. Right-sided central venous catheter noted in situ. No bony abnormality demonstrated
There is bilateral ground glass infiltrate. The main differential for this includes pulmonary hemorrhage and atypical infection. Pulmonary edema is less likely, although non-cardiogenic edema could also be considered
Patient is known to have pANCA vasculitis. Bronchoscopy revealed extensive blood on both sides. No organisms isolated
Pulmonary hemorrhage is very uncommon in PAN, the lungs are usually spared. Hemorrhage is more often seen in other vasculitides, such as Wegener's or in SLE.
In this patient on immunosuppression the other important differential diagnosis is opportunistic infection. Bronchoscopy is diagnostic, revealing blood and bronchial washings showing no organisms.