Learning objectives
The lung is commonly involved in systemic vasculitides with heterogeneous clinical, radiological and histopathological presentations. This pictorial essay focuses on radiological features of pulmonary vasculitides using high-resolution CT (HRCT), providing useful tips to achieve the correct diagnosis and to guide the correct management of these rare multisystemic diseases.
Background
Vasculitis is a systemic inflammatory destructive process of the blood vessels resulting either in ischemia or hemorrhage.The organ involved and vessel size influence the pattern of presentations of the pathology[1].
The most widely used approach to classify primary vasculitis is based on the size of the affected vessels, according to2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides[2][3] Table 1 :
large vessels (aorta and its largest branches)
mediumvessels(main visceral vessels)
smallvessels(capillaries, venules, arterioles).
Even if all types of vasculitis predominantly may have lung...
Findings and procedure details
Radiological features are extremely variable and often represent a clinical challenge to focus on a correct diagnosis[17].
Chest radiography often underestimates the right pattern and extension of thoracic involvement[18]. HRCT is the most reliable method to asses the distribution, characteristics, evolution of these lung diseases and often shows abnormalities even in the absence of clinically significant symptoms[19][20].
Main HRCT findingsinclude:
vessel wall thickening and aneurysmatic dilatation of pulmonary arteries;
scattered multiple uni- or bilateral opacities (Fig.1); lung nodules can possible evolve into cavitary lesion;
micronodules...
Conclusion
The knowledge of HRCT findings - related to specific clinical, laboratory and pathological data - should be mandatory for early and correct diagnosis of vasculitides. It is necessary to recognize their different radiological presentation patterns in order to identify these rare diseases.
Personal information and conflict of interest
C. Ini'; Catania/IT - nothing to disclose L. Fanzone; Catania/IT - nothing to disclose S. Cosentino; Catania/IT - nothing to disclose S. Palmucci; Catania/IT - nothing to disclose L. A. Mauro; Catania/IT - nothing to disclose A. Vancheri; Catania/IT - nothing to disclose C. Vancheri; Catania/IT - nothing to disclose A. Basile; Catania/IT - nothing to disclose R. Grasso; Catania/IT - nothing to disclose
References
[1]Feragalli B, Mantini C, Sperandeo M, Galluzzo M, Belcaro G et al. The lung in systemic vasculitis: radiological patterns and differential diagnosis. Br J Radiol 2016; 89 20150992.
[2]Brown KK. Pulmonary vasculitis. Proc Am Thorac Soc 2006; 3: 48-57.
[3]Jennet JC, Falk RJ. Small-vessel vasculitis. N Engl J Med 1997; 337: 1512-23.
[4] Jennette JC, Falk RJ, Bacon AP, Basu N, Cid MC et al. 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis & Rheumatism. Vol.65, No.1, January 2013, pp 1-11.
[5]Maffessanti...
