PULMONARY ANGIITIS AND GRANULOMATOSIS - RADIOLOGIC-PATHOLOGICAL CORRELATION

Five distinct clinical. syndromes of pulmonary angiitis and granulomat osis are currently recognized: Wegener granulomatosis, lymphomatoid gr anulomatosis, necrotizing sarcoid granulomatosis, bronchocentric granu lomatosis, and allergic angiitis and granulomatosis (Churg-Strauss syn drome). Patients typically present in middle age with fever, cough, he moptysis, dyspnea, or chest discomfort. Upper airway involvement such as sinusitis suggests Wegener granulomatosis. Medical renal disease is associated with Wegener granulomatosis and Churg-Strauss syndrome, As thma may be present in bronchocentric granulomatosis and Churg-Strauss syndrome. Pathologic examination of these entities demonstrates vascu litis, granulomatous inflammation, and parenchymal necrosis, The radio logic manifestations of pulmonary disease are varied, but the most typ ical appearance is that of multiple nodules or masses that may I demon strate cavitation, Diffuse multifocal air-space opacities with or with out cavitation may also be seen. Pulmonary hemorrhage is a well-known presenting manifestation of Wegener granulomatosis and, less commonly, of Churg-Strauss syndrome. Because of the multifocal lung involvement in these diseases, pulmonary metastases and infectious causes are oft en considered in the differential diagnosis. Affected patients are tre ated with cytotoxic agents and corticosteroids. The prognosis is varia ble, depending on the specific syndrome, but may be favorable in the a bsence of significant complications.