1. 2016 합동집담회 증례 발표
서울대학교병원 영상의학과
유진영

2. Case C.C> abnormality on chest PA Hx>
F/42
C.C> abnormality on chest PA
Hx>
Subglottic stenosis w tracheal fenestration
( )

3. Chest PA

4. Chest PA
Chest PA

5. 2011-08-18 CT-Chest+3D(contrast)

6. Patient Medical History
Nasal pain, epistaxis, obstruction( ~)

7. 1999 10-23 PNS Routine(Caldwell, Water’s)

8. Patient Medical History
Nasal pain, epistaxis, obstruction( ~)
Nasal cavity Bx( )
Chronic necrotizing inflammation with multiple granulomatous formation
c/w Granulomatosis with polyangiitis
DOE, inspiratory stridor( ~)

9. 2008-07-17 C-spine(soft tissue) AP & Lat(neut)

10. Patient Medical History
Nasal pain, epistaxis, obstruction( ~)
Nasal cavity Bx( )
Chronic necrotizing inflammation with multiple granulomatous formation
c/w Granulomatosis with polyangiitis
DOE, inspiratory stridor( ~)
d/t subglottic stenosis
tracheal fenestration( )
U/A : RBC 50-99/HPF ( ~)

11. 2011-08-18 CT-Chest+3D(contrast)

12. Chest PA

13. 2012-05-15 CT-Chest+3D(contrast)

14. 2013-10-02 CT-Chest+3D(contrast)

15. 2016-04-12 CT-Chest+3D(contrast)

16. Granulomatosis with polyangiitis(GPA)
Necrotizing granulomatous inflammation usually involving the upper and lower respiratory tract, and necrotizing vasculitis affecting predominantly small to medium vessels
Necrotizing glomerulonephritis is common
C-ANCA : 90% of GPA
Treatment : combination of corticosteroid and cyclophosphamide therapy
Imaging findings
Pulmonary nodules and masses: central cavitation (up to 50%), surrounding ground-glass halo
Ground-glass opacity (GGO) and consolidation
Airway involvement: circumferential smooth or nodular wall thickening
Criteria (EULAR-PRES criteria)
- Upper airway involvement
- Laryngotracheal-bronchial stenoses
- Pulmonary involvement
- Renal involvement
- Histopathologic evidence of granulomatous inflammation
- ANCA positivity
*The presence of ≥ 3 criteria is consistent with the diagnosis of GPA.
EULAR = European League against Rheumatism
PRES = Pediatric Rheumatology European Society
RadioGraphics 2011; 20:1623–1635

17. 1. Nodules and masses : m/c
CT findings of GPA
1. Nodules and masses : m/c
AJR 2009; 192:676–682

18. 2. GGO to lung consolidation : spectrum
CT findings of GPA
2. GGO to lung consolidation : spectrum
3. Airway involvement : subglottic trachea m/c
AJR 2009; 192:676–682

19. Thank You !