2016 합동집담회 증례 발표 서울대학교병원 영상의학과 유진영.

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Presentation transcript:

2016 합동집담회 증례 발표 서울대학교병원 영상의학과 유진영

Case C.C> abnormality on chest PA Hx> F/42 C.C> abnormality on chest PA Hx> Subglottic stenosis w tracheal fenestration (2008.7.18)

2011-08-18 Chest PA

2011-02-22 Chest PA 2011-06-07 Chest PA

2011-08-18 CT-Chest+3D(contrast)

Patient Medical History Nasal pain, epistaxis, obstruction(1999.7 ~)

1999 10-23 PNS Routine(Caldwell, Water’s)

Patient Medical History Nasal pain, epistaxis, obstruction(1999.7 ~) Nasal cavity Bx(1999.10.23) Chronic necrotizing inflammation with multiple granulomatous formation c/w Granulomatosis with polyangiitis DOE, inspiratory stridor(2003.12 ~)

2008-07-17 C-spine(soft tissue) AP & Lat(neut)

Patient Medical History Nasal pain, epistaxis, obstruction(1999.7 ~) Nasal cavity Bx(1999.10.23) Chronic necrotizing inflammation with multiple granulomatous formation c/w Granulomatosis with polyangiitis DOE, inspiratory stridor(2003.12 ~) d/t subglottic stenosis tracheal fenestration(2008.7.18.) U/A : RBC 50-99/HPF (1999.11~)

2011-08-18 CT-Chest+3D(contrast)

2012-05-07 Chest PA

2012-05-15 CT-Chest+3D(contrast)

2013-10-02 CT-Chest+3D(contrast)

2016-04-12 CT-Chest+3D(contrast)

Granulomatosis with polyangiitis(GPA) Necrotizing granulomatous inflammation usually involving the upper and lower respiratory tract, and necrotizing vasculitis affecting predominantly small to medium vessels Necrotizing glomerulonephritis is common C-ANCA : 90% of GPA Treatment : combination of corticosteroid and cyclophosphamide therapy Imaging findings Pulmonary nodules and masses: central cavitation (up to 50%), surrounding ground-glass halo Ground-glass opacity (GGO) and consolidation Airway involvement: circumferential smooth or nodular wall thickening Criteria (EULAR-PRES criteria) - Upper airway involvement - Laryngotracheal-bronchial stenoses - Pulmonary involvement - Renal involvement - Histopathologic evidence of granulomatous inflammation - ANCA positivity *The presence of ≥ 3 criteria is consistent with the diagnosis of GPA. EULAR = European League against Rheumatism PRES = Pediatric Rheumatology European Society RadioGraphics 2011; 20:1623–1635

1. Nodules and masses : m/c CT findings of GPA 1. Nodules and masses : m/c AJR 2009; 192:676–682

2. GGO to lung consolidation : spectrum CT findings of GPA 2. GGO to lung consolidation : spectrum 3. Airway involvement : subglottic trachea m/c AJR 2009; 192:676–682

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