70F Dyspneaand Severe Hemoptysis
Frontal chest radiograph of a 70-year-old woman with severe dyspnea andsevere hemoptysis shows diffuse ground-glass opacities throughout both lungs. These findings, in the clinical context of granulomatosis with polyangiitis (GPA), reflect alveolar hemorrhage secondary to small-vessel vasculitis. Comparison with a study performed seven years earlier for dyspnea demonstrates disease progression and highlights the chronic relapsing nature of GPA.
Ashley Davidoff MD – TheCommonVein.com (140617.lungs)
1 Year later
Scout CT of the chest in a 70-year-old woman with hemoptysis shows marked volume loss of the left lung with air bronchograms and mediastinal shift toward the affected side. One year prior to presentation, CXR demonstrated a dominant consolidation involving the left lower and upper lobes, consistent with progressive granulomatosis with polyangiitis (GPA). These findings highlight the destructive, fibrosing potential of GPA leading to permanent parenchymal loss.
Ashley Davidoff MD – TheCommonVein.com (140618.lungs) 003Lu
Axial CT of the chest (upper: soft tissue windows, lower: lung windows) in a 70-year-old woman with GPA demonstrates necrotizing pneumonia in the left upper lobe and additional bronchopneumonic ground-glass opacities in the right upper lobe and superior segment of the left lower lobe. There is associated mediastinal shift due to parenchymal volume loss, reflecting the destructive sequelae of small-vessel vasculitis and necrotizing inflammation.
Ashley Davidoff MD – TheCommonVein.com (140619.lungs) 003Lu
Axial CT chest in a patient with GPA demonstrates extensive ground-glass opacity in the left lower lobe, most consistent with diffuse alveolar hemorrhage. In addition, there is nodular consolidation in the right lower lobe, a pattern typical of vasculitic granulomatous inflammation. These findings illustrate the dual manifestations of GPA: hemorrhagic small-vessel involvement and necrotizing nodular parenchymal disease.
Ashley Davidoff MD – TheCommonVein.com (140620.lungs) 003Lu
Axial CT of the lower lobes in a 70-year-old woman with GPA (Wegener’s granulomatosis) demonstrates bibasilar ground-glass opacities, greater on the left, consistent with possible alveolar hemorrhage. There is also consolidation in the inferior lingula and evidence of cavitation, reflecting the necrotizing and hemorrhagic components of the disease process. These findings, seen one year prior, underscore the aggressive, multifocal nature of GPA involving both airways and vasculature.
Ashley Davidoff MD – TheCommonVein.com (140621). (003Lu)
Axial CT of the lower lobes in a 70-year-old woman with GPA (Wegener’s granulomatosis) demonstrates consolidation in the lingula and left lower lobe with probable small foci of cavitation. The right lower lobe shows peribronchial thickening, reflecting airway-centered inflammatory involvement. These findings, documented one year prior, highlight the multifocal and destructive nature of GPA, combining parenchymal necrosis with airway inflammation.
Ashley Davidoff MD – TheCommonVein.com (140622) (003Lu)
MIP coronal CT demonstrates extensive ground-glass opacity and consolidation throughout the left lung with associated volume loss. The right lung shows patchy ground-glass opacities involving the mid and lower zones. These findings, seen one year prior, reflect the diffuse hemorrhagic and inflammatory parenchymal involvement characteristic of GPA, with progressive destructive changes more advanced on the left.
Ashley Davidoff MD – TheCommonVein.com (140624) (Case 003Lu)
Interval Improvement with Residual Changes
Frontal chest radiograph shows significant improvement in aeration compared with prior studies, with restoration of left lung volume. A large cystic space remains in the left upper lobe, likely reflecting sequelae of prior cavitation. There is a persistent loculated left pleural collection, presumed chronic, and mild bilateral scarring. An overlying right breast implant is also noted. These current findings illustrate partial resolution of GPA-related pulmonary disease with residual structural damage.
Ashley Davidoff MD – TheCommonVein.com (140626) (Case 003Lu)
Lateral chest radiograph from the current study shows improved lung volumes with persistent mid-lung scarring and a large cystic space in the left upper lobe. There is evidence of a loculated left pleural collection and bilateral parenchymal scarring. The right breast prosthesis is visualized anteriorly. These findings highlight residual structural sequelae of GPA despite interval improvement in overall aeration.
Ashley Davidoff MD – TheCommonVein.com (140626) (Case 003Lu)
Granulomatosis with Polyangiitis – Large Residual Loculated Cavity
Axial CT at the level of the upper lungs and trachea demonstrates a large thin-walled loculated cavity, consistent with a residual space from prior necrotizing pneumonia. The cavity shows cystic morphology without active soft tissue components, representing chronic sequelae rather than acute infection. These current findings underscore the destructive potential of GPA and the persistence of cavitary changes even after disease control.
Ashley Davidoff MD – TheCommonVein.com (140627) (Case 003Lu)
Coronal CT at the level of the right mainstem bronchus shows a large thin-walled loculated cavity in the left upper lobe, residual from prior necrotizing pneumonia. There is associated left upper lobe volume loss and a mild residual atelectatic abnormality in the superior aspect of the left lower lobe. These current findings illustrate the chronic post-inflammatory sequelae of GPA, combining cavitary destruction with persistent parenchymal collapse.
Ashley Davidoff MD – TheCommonVein.com (140631) (Case 003Lu)
Axial CT through the lower lobes shows interval resolution of prior bilateral abnormalities involving the lower lobes and inferior lingula. Lung parenchyma demonstrates improved aeration without residual consolidation or ground-glass opacity. These current findings highlight the potential for partial recovery in GPA following treatment, contrasting with areas of persistent scarring and cavitation elsewhere.
Ashley Davidoff MD – TheCommonVein.com (140629) (Case 003Lu)
Coronal CT at the level of the left atrium demonstrates a large thin-walled loculated cavity in the left upper lobe, representing a residual space from prior necrotizing pneumonia. There is associated volume loss of the left upper lobe and a mild residual atelectatic abnormality likely involving the superior aspect of the left lower lobe. These current findings underscore the chronic sequelae of GPA, where destructive parenchymal processes leave behind persistent cavitary and atelectatic changes.
Ashley Davidoff MD – TheCommonVein.com (140630) (Case 003Lu)
Axial CT through the upper lobes demonstrates a thin-walled loculated cavity consistent with a residual space from prior necrotizing pneumonia. There is associated mild scarring and volume loss, with cystic change in the affected region. These current findings reflect chronic sequelae of GPA, where destructive inflammatory processes leave behind structurally altered but inactive cavities.
Ashley Davidoff MD – TheCommonVein.com (140628) (Case 003Lu)
70F-year old female presents with hemoptysis and bilateral lower lobe pulmonary infiltrates.
Combination of Ground Glass Infiltrates and Consolidation with Some Nodules Dominantly Involving the Left Lower and Upper Lobe
70F-year old female presents with hemoptysis and bilateral lower lobe pulmonary infiltrates CT scan shows a ground glass opacity in the left lower lobe and subsegmental consolidations and ground glass nodules in the right lower lobe Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-012
Necrosis within the Consolidation
70F-year old female presents with hemoptysis and bilateral lower lobe pulmonary infiltrates CT scan shows a consolidation in the left lower lobe with early cavitation, and segmental airway thickening and ground glass nodules in the right lower lobe
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-014
70F-year old female presents with hemoptysis and bilateral lower lobe pulmonary infiltrates CT scan shows a multiple nodules associated with the tracheobronchial tree in the in in the right lower lobe associated with subtending blood vessels
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-019
70F-year old female presents with hemoptysis and bilateral lower lobe pulmonary infiltrates CT scan shows a multiple ground glass nodules in the in the right lower lobe associated with blood vessels and dense consolidations in the left upper and left lower lobe
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-020
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-021
70F-year old female presents with hemoptysis and bilateral lower lobe pulmonary infiltrates CT scan shows dense consolidations in the left upper lobe
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-010
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-018
1 year later
70F-year old female presents 1 year after an episode of severe hemoptysis and bilateral lower lobe pulmonary infiltrate. CXR shows a large cavity in the left upper lobe and a shrunken left hemithorax
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-022
70F-year old female presents 1 year after an episode of severe hemoptysis and bilateral lower lobe pulmonary infiltrate. CXR shows a large cavity in the left upper lobe and a shrunken left hemithorax
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-022
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-024
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-018
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-027
Ashley Davidoff MD TheCommonVein.net Wegeners-cavitation-028
Radiographics