Thoracic manifestation of Wegener's granulomatosis: Computed tomography findings and analysis of misdiagnosis

Abstract

The aim of the present study was to investigate the computed tomography (CT) manifestations of Wegener granulomatosis (WG) in the chest and potential reasons for misdiagnosis. Conventional CT scans and clinical data of 45 patients with WG were retrospectively analyzed. Patients typically presented with multiple system involvement, primarily in the upper and lower respiratory tract. The incidence of thoracic involvement was 75.56% (34/45). Radiographic features were varied between cases in the present study, with the most common features being numerous cavitary nodules and masses in the lungs. Cavitations were usually irregular, with uneven wall thickness, partial centrality, fuzzy inner edges and piecemeal necrosis. These results indicate that WG typically has multiple system involvement, with the chest being most prominent. Multiple variable-sized cavitary nodules with irregular edges and piecemeal necrosis were the most notable features revealed using CT scanning; however, in order to give a definitive diagnosis, biopsies should be performed.

Keywords: Wagener's granulomatosis; X-ray computed; diagnostic errors; tomography.

Figure 1.

Wegener's granulomatosis in a 58-year-old female. Computed tomography scanning revealed multiple nodules and irregular masses in bilateral lungs, necrotizing cavities in the local lesions (black arrow), ground glass opacity in the outline of the lesion (dovetail arrow) and pleural thickening adjacent to the lesion (white arrow).

Figure 2.

Wegener's granulomatosis in a 51-year-old female. Computed tomography scanning revealed (A) irregular nodules and cavitations in the left inferior lobar basal segment. (B) Following hormone treatment for 1 month (black arrow) the local lesion was reduced, necrotizing cavitations were larger and piecemeal necrosis was observed in cavitations (black arrow).

Figure 3.

Wegener's granulomatosis in a 67-year-old male. Computed tomography scanning revealed lobar consolidation and irregular necrosis (arrows) in a large area of right lung.

Figure 4.

Wegener's granulomatosis in a 47-year-old female. Computed tomography scanning revealed diffuse small nodules with a centrilobular distribution (white arrow).

Figure 5.

Wegener's granulomatosis in a 49-year-old woman. Computed tomography scanning revealed punctiform soft tissue density nodules in the main trachea (black arrow).

Figure 6.

Wegener's granulomatosis in a 71-year-old male. Computed tomography scanning revealed a marked filling defect in bilateral pulmonary artery (white arrow).

Figure 7.

Computed tomography scanning of a patient with WG misdiagnosed as infectious lesions. (A) Irregular consolidation in the substrate out of left lower lung, and punctiform vesicle in the consolidation (black arrow). (B) At 3 months post predisone treatment, the lesion markedly reduced in size and evolved into a cavity with a thin-wall (black arrow).

Figure 8.

Computed tomography scanning of Wegener's granulomatosis misdiagnosed as tumor-like lesion. Nodules with irregular shapes were dispersed in the lung (black arrows).