You are asked to review this CXR by the ICU. CXR of a 28 year old male ‘ANCA positive’ with renal failure.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is patchy, diffuse airspace shadowing in both lung fields, worse on the left side.
There is a large tunneled subclavian IV access cannula in situ on the right.
This man had microscopic polyangiitis (MPA) with MPO-ANCA (old term: p-ANCA) positive staining
The vascath is for dialysis following acute renal failure. The infiltrates could represent some fluid overload, however, in the context of being ‘ANCA positive’, inflammatory infiltrates are likely. .
High dose corticosteroid therapy followed by cyclophosphamide or azathioprine, and more recently rituximab (with continued steroids), is indicated for MPA.