eMedicine Specialties > Radiology > Chest

Wegener Granulomatosis, Thoracic: Multimedia

Author: James G Ravenel, MD, Associate Professor of Radiology, Vice Chair for Education, Chief of Thoracic Imaging, Department of Radiology, Medical University of South Carolina
Coauthor(s): Abid Irshad, MD, Assistant Professor, Department of Radiology, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Oct 21, 2008

Multimedia

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Media file 1: Wegener granulomatosis, thoracic. Posteroanterior chest radiograph in a middle-aged man with Wegener granulomatosis shows heterogeneous airspace opacity, which occurs predominately in the lower lobes, and a focal ill-defined opacity in the right upper lobe. Findings are suggestive of pulmonary hemorrhage (see Images 2-3).

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Wegener granulomatosis, thoracic. Posteroanterior chest radiograph in a middle-aged man with Wegener granulomatosis shows heterogeneous airspace opacity, which occurs predominately in the lower lobes, and a focal ill-defined opacity in the right upper lobe. Findings are suggestive of pulmonary hemorrhage (see Images 2-3).

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Media file 2: Wegener granulomatosis, thoracic. Image obtained 4 months later in the same patient as in Image 1 shows nearly complete resolution of lower lobe airspace disease, with partial resolution of the right upper lobe opacity. A new cavity is present in the left upper lobe.

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Wegener granulomatosis, thoracic. Image obtained 4 months later in the same patient as in Image 1 shows nearly complete resolution of lower lobe airspace disease, with partial resolution of the right upper lobe opacity. A new cavity is present in the left upper lobe.

(Enlarge Image)

Media file 3: Wegener granulomatosis, thoracic. Image obtained 1 year after Image 2 shows that the left upper lobe cavity has enlarged, without a change in wall thickness. Multiple new cavitary and noncavitary nodules are present in the right lung.

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Wegener granulomatosis, thoracic. Image obtained 1 year after Image 2 shows that the left upper lobe cavity has enlarged, without a change in wall thickness. Multiple new cavitary and noncavitary nodules are present in the right lung.

(Enlarge Image)

Media file 4: Wegener granulomatosis, thoracic. Thick-walled right upper lobe cavity in Wegener granulomatosis.

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Wegener granulomatosis, thoracic. Thick-walled right upper lobe cavity in Wegener granulomatosis.

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Media file 5: Wegener granulomatosis, thoracic. Cut surface of a gross pathologic specimen that corresponds to Image 4 shows a thick-walled cavity with internal hemorrhage and necrosis. Courtesy of Russell Harley, MD.

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Wegener granulomatosis, thoracic. Cut surface of a gross pathologic specimen that corresponds to Image 4 shows a thick-walled cavity with internal hemorrhage and necrosis. Courtesy of Russell Harley, MD.

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Media file 6: Wegener granulomatosis, thoracic. Wegener granulomatosis is present as a single pulmonary mass. Chest radiograph shows a single right lower-lobe mass.

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Wegener granulomatosis, thoracic. Wegener granulomatosis is present as a single pulmonary mass. Chest radiograph shows a single right lower-lobe mass.

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Media file 7: Wegener granulomatosis, thoracic. CT scan of the patient in Image 5 shows a well-circumscribed right lower-lobe mass. Biopsy revealed necrotizing granulomatous vasculitis, which is consistent with Wegener granulomatosis.

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Wegener granulomatosis, thoracic. CT scan of the patient in Image 5 shows a well-circumscribed right lower-lobe mass. Biopsy revealed necrotizing granulomatous vasculitis, which is consistent with Wegener granulomatosis.

(Enlarge Image)

Media file 8: Wegener granulomatosis, thoracic. CT image obtained with lung window settings show a typical appearance of nodules in Wegener granulomatosis. Multiple ill-defined peripheral nodules have a halo with a ground-glass appearance. The halo is thought to represent adjacent pulmonary hemorrhage.

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Wegener granulomatosis, thoracic. CT image obtained with lung window settings show a typical appearance of nodules in Wegener granulomatosis. Multiple ill-defined peripheral nodules have a halo with a ground-glass appearance. The halo is thought to represent adjacent pulmonary hemorrhage.

(Enlarge Image)

Media file 9: Wegener granulomatosis, thoracic. Three-dimensional shaded-surface display of the trachea shows eccentric narrowing of the subglottic trachea in this patient with airway involvement from Wegener granulomatosis.

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Wegener granulomatosis, thoracic. Three-dimensional shaded-surface display of the trachea shows eccentric narrowing of the subglottic trachea in this patient with airway involvement from Wegener granulomatosis.

More on Wegener Granulomatosis, Thoracic

Overview: Wegener Granulomatosis, Thoracic

Imaging: Wegener Granulomatosis, Thoracic

Follow-up: Wegener Granulomatosis, Thoracic

Multimedia: Wegener Granulomatosis, Thoracic

References

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Allen NB. Wegener's granulomatosis. In: Goldman L Bennett JC, eds. Cecil Textbook of Medicine. 21st ed. 2000: 1529-32.
Cordier JF, Valeyre D, Guillevin L, et al. Pulmonary Wegener''s granulomatosis. A clinical and imaging study of 77 cases. Chest. Apr 1990;97(4):906-12. [Medline].
Langford CA. Wegener''s granulomatosis: current and upcoming therapies. Arthritis Res Ther. 2003;5(4):180-91. [Medline].
Woywodt A, Haubitz M, Haller H, Matteson EL. Wegener's granulomatosis. Lancet. Apr 22 2006;367(9519):1362-6. [Medline].
Cordier JF. [Pulmonary manifestations of the vasculitides]. Rev Prat. Mar 15 2008;58(5):492-8. [Medline].
Pagnoux C. [Wegener's granulomatosis and microscopic polyangiitis]. Rev Prat. Mar 15 2008;58(5):522-32. [Medline].
Feder BJ. A Nazi Past Casts a Pall on Name of a Disease. New York Times. January 22, 2008;Health: Available at http://www.nytimes.com/2008/01/22/health/22dise.html?_r=2&oref=slogin&oref=slogin.
Rosen MJ. Dr. Friedrich Wegener, the ACCP, and History. Chest. Sep 2007;132(3):739-41. [Medline].
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Leavitt RY, Fauci AS, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Wegener''s granulomatosis. Arthritis Rheum. Aug 1990;33(8):1101-7. [Medline].
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Hayashi H, Morimoto K, Nakazawa K, Fujita J, Mori T, Sunada K, et al. [A case of limited form of Wegener's granulomatosis showing repeated occurrence and disappearance of nodules in chest X ray with no medication]. Nihon Kokyuki Gakkai Zasshi. Sep 2007;45(9):726-30. [Medline].
Maskell GF, Lockwood CM, Flower CD. Computed tomography of the lung in Wegener''s granulomatosis. Clin Radiol. Dec 1993;48(6):377-80. [Medline].
Reuter M, Schnabel A, Wesner F, et al. Pulmonary Wegener''s granulomatosis: correlation between high-resolution CT findings and clinical scoring of disease activity. Chest. Aug 1998;114(2):500-6. [Medline].
Oliveira GH, Seward JB, Tsang TS, Specks U. Echocardiographic findings in patients with Wegener granulomatosis. Mayo Clin Proc. Nov 2005;80(11):1435-40. [Medline].
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Keywords

Wegener's granulomatosis, Wegener granulomatosis, necrotizing granulomatous vasculitis of the upper and lower respiratory tract, glomerulonephritis, small-vessel vasculitis, rhinogenic granulomatosis, classic Wegener granulomatosis, classic Wegener's granulomatosis, glomerulonephritis, lung disease, kidney disease

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Contributor Information and Disclosures

Author

James G Ravenel, MD, Associate Professor of Radiology, Vice Chair for Education, Chief of Thoracic Imaging, Department of Radiology, Medical University of South Carolina
James G Ravenel, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of Program Directors in Radiology, Association of University Radiologists, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Abid Irshad, MD, Assistant Professor, Department of Radiology, Medical University of South Carolina
Abid Irshad, MD is a member of the following medical societies: Radiological Society of North America and Society of Breast Imaging
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey A Miller, MD, Associate Professor of Clinical Radiology, University of Medicine and Dentistry of New Jersey; Associate Chief of Service, Department of Radiology, Veterans Affairs of New Jersey Health Care System
Jeffrey A Miller, MD is a member of the following medical societies: North American Society for Cardiac Imaging, Society for Health Services Research in Radiology, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

John D Newell, Jr, MD, FACR, FCCP, FASER, Co-Director of Thoracic Imaging, UCDHSC; Director of Lung Imaging Center, Professor of Radiology and Professor of Medicine, Department of Radiology, University of Colorado Health Sciences Center, National Jewish Medical and Research Center; Univ. Colorado Hospital
John D Newell, Jr, MD, FACR, FCCP, FASER is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, American Thoracic Society, Association of University Radiologists, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Siemens Medical Grant/research funds Consulting; Forevision Technologies Ownership interest Consulting; Vida Corporation Ownership interest Board membership; TeraRecon Grant/research funds Consulting; eMedicine Honoraria Consulting

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Clinical Assistant Professor of Radiology, University of Washington Medical School
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Chest

Wegener Granulomatosis, Thoracic: Multimedia

Multimedia

Wegener granulomatosis, thoracic. Image obtained 4 months later in the same patient as in Image 1 shows nearly complete resolution of lower lobe airspace disease, with partial resolution of the right upper lobe opacity. A new cavity is present in the left upper lobe.

Wegener granulomatosis, thoracic. Image obtained 1 year after Image 2 shows that the left upper lobe cavity has enlarged, without a change in wall thickness. Multiple new cavitary and noncavitary nodules are present in the right lung.

Wegener granulomatosis, thoracic. Thick-walled right upper lobe cavity in Wegener granulomatosis.

Wegener granulomatosis, thoracic. Cut surface of a gross pathologic specimen that corresponds to Image 4 shows a thick-walled cavity with internal hemorrhage and necrosis. Courtesy of Russell Harley, MD.

Wegener granulomatosis, thoracic. Wegener granulomatosis is present as a single pulmonary mass. Chest radiograph shows a single right lower-lobe mass.

Wegener granulomatosis, thoracic. CT scan of the patient in Image 5 shows a well-circumscribed right lower-lobe mass. Biopsy revealed necrotizing granulomatous vasculitis, which is consistent with Wegener granulomatosis.

Wegener granulomatosis, thoracic. CT image obtained with lung window settings show a typical appearance of nodules in Wegener granulomatosis. Multiple ill-defined peripheral nodules have a halo with a ground-glass appearance. The halo is thought to represent adjacent pulmonary hemorrhage.

Wegener granulomatosis, thoracic. Three-dimensional shaded-surface display of the trachea shows eccentric narrowing of the subglottic trachea in this patient with airway involvement from Wegener granulomatosis.

More on Wegener Granulomatosis, Thoracic

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor