Background Lung involvement is not only a presenting finding but also might have widespread pathologic findings in Granulomatosis with Poliangitis (GPA). Even though chest computed tomography (CT) has superior sensitivity and specificity for evaluation of the airways, lung parenchyma and mediastinum, there are only a few studies regarding detailed analysis of Chest CT findings in GPA.
Objectives To evaluate pulmonary pathologies in GPA at the time of diagnosis with CT.
Methods Hacettepe University Vasculitis center is one of the main referral centers in the country. All patients starting from October 2014 have been included and defined according to the 2012 revised Chapel Hill nomenclature criteria. Our database was screened for patients with GPA. Totally 98 patients were evaluated and 43 patients were excluded since missing data. Fifty-five patients (Female: 31 (56.4%), were included in further analysis. Demographic and clinical findings were recorded. CT scans were read by two different radiologists who were aware of the diagnosis GPA, but unaware of the phase of disease. Final CT findings were reached in consensus. The following CT findings were evaluated: Parenchymal nodules or masses, ground-glass opacification or consolidation, tracheobronchial involvement, pleural irregularities, pleural effusions, hilar and mediastinal lymphadenopathy, cardiomegaly, pericardial effusions and vascular abnormality.
Results The mean age was 51.5 (16.0) years and ANCA positivity (MPOANCA/ PR3ANCA: 15/29) was in 80% of patients. 76.4% of patients (n=42) have any of CT findings. In 70.9% (n=39) of patients had parenchymal involvement and most commonly observed findings were nodules/masses in 24 (43.6%) patients, ground-glass opacification or consolidation in 22 (40.0%) patients. These parenchymal findings were bilateral in 87.2% (34/39) of patients. A combination of both patterns were also available in 17.9% (7/39) of patients. Of examinations with nodules; 70.8% (17/24) demonstrated more than five nodules, and 33.3% (8/24) had cavitary lesions. Pleural effusions were seen in 13 patients (23.6%) and 46.2% (6/13) of them were bilateral. Hilar or mediastinal lymph node enlargement was discovered in 6 (10.9%) patients and all also had parenchymal involvement. In only two patients had tracheobronchial involvement; one was subglottic stenosis, the other was thickening of bronchial wall. Pericardial effusion and/or cardiomegaly was detected in 9 (16.4%) patients and all these patients also had parenchymal involvement. In subgroup analysis according to ANCA positivity and sex, pulmonary nodules/masses were more frequent in ANCA positive patients (50%vs. 18.2%, p=0.057). And ground-glass opacification or consolidation were more often in males (54.2% vs. 29.0%, p=0.059).
Conclusions Even though at disease onset, most of GPA patients had any of pulmonary pathologies observed by CT. Not only nodules/masses and consolidation/ground-glass opacification were seen but also pericardial effusion and/or cardiomegaly, tracheobronchial involvement and subglottic stenosis could be found. ANCA positivity and sex might contribute pulmonary pathologies. Further studies are required.
Disclosure of Interest None declared