Pace C, Presicce M, Lamacchia F, Ferrari D, Sergiacomi G
Department of Diagnostic Imaging, University of Rome Tor Vergata, Rome, Italy.
Radiol Case Rep. 2019 Nov 9;15(1):54-58. doi: 10.1016/j.radcr.2019.09.037. eCollection 2020 Jan.
We describe a case of 85-year-old man who presented to the Emergency Department with sudden dyspnea. He had a past medical history of cardiomyopathy and radiography and nonenhanced computed tomography (CT) of the chest showed pulmonary edema. Despite intravenous diuretic therapy, there was no clinical improvement. Cardiac CT was then performed showing a solid pulmonary nodular lesion with intralesional cavitations, ground-glass opacities, and peripheral vascularization. CT-guided needle lung biopsy yielded a diagnosis of granulomatosis with polyangiitis (Wegener granulomatosis). Medical treatment with cyclophosphamide and prednisone produced rapid symptomatic improvement and complete resolution of the radiological findings. This case demonstrates the challenges in making this diagnosis in an elderly patient with heart disease. We found very few documented cases where there was onset of granulomatosis with polyangiitis at this age.
我们描述了一例85岁男性患者，他因突发呼吸困难就诊于急诊科。他有心肌病病史，胸部X线和非增强计算机断层扫描（CT）显示肺水肿。尽管进行了静脉利尿剂治疗，但临床症状并无改善。随后进行的心脏CT显示肺部有一个实性结节性病变，伴有病灶内空洞、磨玻璃影和周边血管化。CT引导下经皮肺穿刺活检确诊为肉芽肿性多血管炎（韦格纳肉芽肿）。环磷酰胺和泼尼松药物治疗使症状迅速改善，影像学表现完全消退。该病例显示了在患有心脏病的老年患者中做出此诊断的挑战。我们发现很少有文献记载在这个年龄段出现肉芽肿性多血管炎的病例。
