how was your summer? My summer was great and I am ready to present some fresh cases!
Just to warm you up, here is a case recently shown to me in Hospital Dr Peset.
This is a 38 year old male with upper respiratory symptoms.
Final solution:
The CXR showed multiple cavitated masses/nodules in both lungs (arrows). The differential diagnosis of cavitated pulmonary lesions is mainly: Tuberculosis and other granulomatous infections, septic embolisms, rheumatoid nodules, metastasis and vasculitis.
CT Demonstrated the cavitated masses/nodules in both lungs.
Cranial CT.
Frontoethmoidal Sinusitis with extension to the extraconal orbit (a), and rupture of the lamina propia. (b) There is also an oro-antral fistula (c).
DIAGNOSIS: The association of cavitated lesions with sinusitis and upper respiratory symptoms has to make you think of vasculitis, especially Granulomatosis with polyangiitis ( formerly Wegener).
The cANCA test was positive as it occurs in the majority of cases.
Granulomatosis with polyangiitis is a vasculitis that involves multiple structures and thus has a spectrum of clinical presentations, mainly related to the lungs and upper respiratory tract.
This slide from my friend and colleague Eva Castañer ( Barcelona) shows the main features of Granulomatosis with Polyangiitis (Wegener).
Point to remember:
Cavitated masses in the lungs: Pay attention to the accompanying clinical scenario.
(Remember that cavitation of masses and nodules in the lungs is different from pulmonary cysts.)
Azygous lobe consolidation
Cavitating lesion in right upper lobe.
A nodular lesion in right lower zone.
A few small cavitating lesions in both lungs.
My first possibility could be septic emboli.(? History of fever / history of any infective focus) Differential 1. Rheumatoid nodule with cavitation, 2. cavitating metastasis from squamous primary.
https://radiopaedia.org/articles/pulmonary-cavity-mnemonic?lang=us
Oesophagus dilated?
This patient had long standing upper respiratory symptoms, with sinusitis.
Perhaps, histoplasmosis ?
Wegener disease
Multiple cavitating lung nodules with history of sinusitis would be suspicious for granulomatosis with polyangiitis (Wegener’s).
Wegener’s granulomatosis (cavitating lesions, sinusitis, RT hilar lympadenopathy?)
Correlation with c-ANCA level