WEGENERS GRANULOMATOSIS UPPER RESPIRATORY-TRACT AND PULMONARY RADIOGRAPHIC MANIFESTATIONS IN 30 CASES WITH PATHOGENETIC CONSIDERATION

Although the radiographic manifestations and pathologic features of We gener's granulomatosis have been well described, their relationship to two variants of antineutrophil cytoplasmic antibodies (c-and p-ANCA) remains unclear. The purposes of this study are to analyze the radiogr aphic and pathologic findings in 30 patients with Wegener's granulomat osis and to correlate c-and p-ANCA with such findings. Major histologi c findings included parenchymal necrosis, necrotizing vasculitis, and granulomatous inflammations. Nodular lesions were more often associate d with arteritis whereas patchy fluffy lesions associated with hemorrh agic capillaritis. ANCAs, particularly c-ANCA, instead of p-ANCA, were present in a high percentage of patients tested. These findings sugge st that c-ANCA could play an important pathogenetic role in Wegener's granulomatosis which showed dual pathologic processes: vasculitis and granulomatous inflammation manifested radiographically as either nodul ar or pneumonia-like lesions, whereas p-ANCA was more often associated with patchy fluffy lung lesions as the consequence of hemorrhagic cap illaritis. (C) Elsevier Science Inc., 1998.