CXR Case 078
A 54 year old man presents in severe respiratory distress with haemoptysis, and renal failure.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
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.
Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar | ICIS Course ANZ