Asymmetrical hemithorax volume loss due to Wegener's granulomatosis

Three patients with Wegener's granulomatosis (WG) established by clinical, serological and histological criteria were noted to have marked asymmetrica l hemithorax volume loss on thoracic CT. Lung dimensions were analysed from the CT in each case. Evidence of airways disease, parenchymal abnormalitie s and pleural changes was evaluated on CT, in order to establish the aetiol ogy of the volume loss. Previous pulmonary infection and thoracic intervent ion were excluded by the clinical data. The three patients had chronic trea ted thoracic WG for 1-9 years. There was severe asymmetrical pleural diseas e in one case and parenchymal disease with evidence of fibrotic healing but no evidence of bronchial disease in two cases. Marked asymmetrical volume loss of a hemithorax is a previously unreported finding and should be added to the features of primary chronic thoracic WG. This finding does not requ ire investigation for additional pathology.