The thoracic CT manifestations and pathologic basis of pulmonary Wegener granulomatosis / 中国医师进修杂志

ABSTRACT

Objective To explore the thoracic CT manifestations and pathologic basis of pulmonary Wegener granulomatosis (WG),in order to improve the diagnostic accuracy.Methods Eighteen patients with pulmonary WG confirmed by pathology were collected.All the patients underwent CT scan and enhanced scan with 64-slice volume CT.CT features and clinical symptoms were retrospectively reviewed.Results The pathological manifestations of 18 cases with pulmonary WG were miscellaneous,including necrotizing granuloma infiltrated with inflammatory cells,intrapulmonary vasculitis,parenchymal necrosis,hemorrhage of pulmonary alveolus,microabscess and so on.Thoracic CT manifestationsmultiple nodules were seen in 7 cases,multiple masses were detected in 4 cases,cavitations showed in 10 cases,peripheral wedge-shaped shadows showed in 2 cases,ground-glass attenuation and consolidation showed in 2 cases,bronchial wall thickening in 2 cases,solitary pulmonary nodule or mass in 3 cases,pleural effusion was seen in 5 cases.All the nodules,masses and cavitations demonstrated inhomogeneous and ring enhancement on contrast-enhanced images.Some patients presented with varied kinds of the above lesions,which could transform each other and became more or less.Conclusions Pulmonary WG has many pathological manifestations,resulting in the variety of the thoracic CT manifestations.The main manifestations are multiple nodules and multiple masses,necrotic cavitations.The feeding vessel sign to a nodule or mass and ring-shade cavity are relatively characteristics to diagnose pulmonary WG.The correct diagnosis could be established on the bases of understanding of the special developments and pathology of the lesions.