CXR Case 078

There is widespread, bilateral airspace opacification with air bronchograms.
The peripheries are relatively spared.
ETT, central venous access and NGT are noted.

This is granulomatosis with polyangiitis (‘GPA‘) – old school Wegener’s granulomatosis.
The renal failure is from associated glomerulonephritis. PR-3 ANCA (c-ANCA) was positive.
High dose corticosteroids was started, followed by cyclophosphamide – he survived.
The differential of the CXR includes a severe (infective) pneumonia.

Other radiological appearances of GPA are nodules that may or may not be cavitating.

Upper airways symptoms are very common in GPA (~95%) such as nasal stuffiness, nasal discharge, epistaxis,  and upper airway (and mouth) ulcers.