CT APPEARANCE OF PULMONARY VASCULITIS IN CHILDREN

OBJECTIVE. The aim of this study was to determine whether a CT pattern that may represent early or subtle changes of pulmonary vasculitis in children exists. MATERIALS AND METHODS. High-resolution CT scans of t he chest for 107 children were retrospectively reviewed by two radiolo gists who were unaware of the original study findings. Chest CT scans (conventional) for another 54 children who had symptoms or a diagnosis of vasculitis also were reviewed. RESULTS. We identified hazy or fluf fy centrilobular, perivascular densities in 10 children, two of whom h ad small airways disease and eight of whom had vasculitis (Wegener's g ranulomatosis [n = 5], systemic lupus erythematosus [n = 1], scleroder ma-polymyositis overlap syndrome [n = 1], and Churg-Strauss syndrome [ n = 1]). The latter eight children underwent 35 scans, 17 of which wer e positive for these perivascular densities. All positive scans were a ssociated with active disease of new onset (5/17) or with clinical exa cerbation of preexisting systemic disease (12/17). The positive scans also were associated with an elevated erythrocyte sedimentation rate ( 13/17) and biopsy evidence of vasculitis from a variety of sites, incl uding the lungs (n = 1), kidneys (n = 7), oropharynx (n = 5), skin (n = 9), lymph nodes (n = 1), and myocardium (n = 2). The single lung bio psy showed an angiocentric inflammatory-hemorrhagic process. Of the fi ve patients who had positive scans, underwent therapy, and then had re peat studies, four patients had scans revert to normal in association with inactive disease. The remaining patient whose scan did not normal ize failed to respond to treatment. CONCLUSION. The fluffy centrilobul ar pattern likely represents subtle changes of pulmonary vasculitis. I n the appropriate clinical setting, such a finding may obviate the nee d for a lung biopsy.