Pulmonary Imaging Findings of Vasculitis
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PULMONARY RADIOLOGY (M STEPHENS AND S KAPUR, SECTION EDITORS)
Pulmonary Imaging Findings of Vasculitis Matthew J. Stephens 1
&
Ayaz Aghayev 2
Accepted: 30 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this article is to review the various pulmonary imaging findings that may be present in patients with various types of vasculitis. The review will also go over the potential clinical significance of the various findings. Recent Findings The majority of pulmonary findings related to vasculitis revolve around granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA). Additional etiologies are rare and mostly present as diffuse alveolar hemorrhage when small vessels are involved and aneurysms when medium and large vessels are involved. Summary Pulmonary imaging findings related to vasculitis vary widely across etiologies. While many of these manifestations are rare, it is important to be familiar with them as they can cause severe complications. Keywords Vasculitis . Pulmonary . Computed Tomography . Radiology . Imaging, ANCA-associated vasculitis . Antiglomerular basement membrane disease . Antiphospholipid syndrome . Behçet syndrome . Diffuse alveolar hemorrhage . Granulomatosis with polyangiitis (Wegener) . Microscopic polyangiitis . Takayasu arteritis
Introduction Cellular inflammation of the vessel walls, also called vasculitis, is a multisystem disease with a variety of causes. It is often difficult to diagnose and manage given signs and symptoms often overlap with infection, malignancy, connective tissue disease, and medication reactions. There are several types of vasculitis that involve the vessels of the lungs. Depending on the vessels involved and the underlying cause of the vasculitis, this can give various presentations on imaging. Understanding these common patterns on imaging can help in the diagnosis and classification of the different types of vasculitis. Vasculitis can be classified by the size of vessel involved and the underlying etiology [1]. When vasculitis is classified by size, it is usually categorized as small, medium, or large vessel vasculitis. The different-sized vasculotides are further This article is part of the Topical Collection on Pulmonary Radiology * Matthew J. Stephens [email protected] 1
Department of Radiology, University of Cincinnati School of Medicine, Cincinnati, OH, USA
2
Cardiovascular Imaging Program, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
categorized by etiology. In this review, we will go through each class of vasculitis and the pulmonary imaging manifestations that may present with each type.
Small Vessel Small vessel vasculitis affects capillaries, venules, and arterioles. Most commonly, they affect patients 50–69 years old but can occur in patients of all ages. Small vessel vasculitis can be divided into four major categories including idiopathic, immune complex–mediated vasculi
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