CXR Case 078

A 54 year old man presents in severe respiratory distress with haemoptysis,  and renal failure.

CXR CASE 078 CXR LITFL

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.


CLINICAL CORRELATION

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.


CLINICAL PEARLS

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.


TOP 150 CXR SERIES



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 |

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