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2016 합동집담회 증례 발표 서울대학교병원 영상의학과 유진영
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Case C.C> abnormality on chest PA Hx>
F/42 C.C> abnormality on chest PA Hx> Subglottic stenosis w tracheal fenestration ( )
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Chest PA
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Chest PA Chest PA
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2011-08-18 CT-Chest+3D(contrast)
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Patient Medical History
Nasal pain, epistaxis, obstruction( ~)
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1999 10-23 PNS Routine(Caldwell, Water’s)
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Patient Medical History
Nasal pain, epistaxis, obstruction( ~) Nasal cavity Bx( ) Chronic necrotizing inflammation with multiple granulomatous formation c/w Granulomatosis with polyangiitis DOE, inspiratory stridor( ~)
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2008-07-17 C-spine(soft tissue) AP & Lat(neut)
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Patient Medical History
Nasal pain, epistaxis, obstruction( ~) Nasal cavity Bx( ) Chronic necrotizing inflammation with multiple granulomatous formation c/w Granulomatosis with polyangiitis DOE, inspiratory stridor( ~) d/t subglottic stenosis tracheal fenestration( ) U/A : RBC 50-99/HPF ( ~)
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2011-08-18 CT-Chest+3D(contrast)
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Chest PA
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2012-05-15 CT-Chest+3D(contrast)
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2013-10-02 CT-Chest+3D(contrast)
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2016-04-12 CT-Chest+3D(contrast)
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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
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1. Nodules and masses : m/c
CT findings of GPA 1. Nodules and masses : m/c AJR 2009; 192:676–682
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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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