A Clinicoradiologic Approach to Diagnosing Pulmonary Vasculitis (Slideshow)

The diagnosis and management of the primary vasculitides is often difficult given that the clinical features of each disease depend on site, degree of severity and other factors, and that many patients present with nonspecific symptoms. Pulmonary vasculitis describes vasculitides with increased involvement of the respiratory system and is usually a facet of systemic vasculitis.

Imaging techniques such as chest radiography, CT and MRI can often help a multidisciplinary team of experts move toward the correct diagnosis. When correlated with laboratory findings, rheumatology and pulmonology consults, imaging can be a vital tool in the diagnosis of pulmonary vasculitis.

The following images demonstrate the radiologic findings and diagnostic clues of several types of pulmonary vasculitis.

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A 38-year-old woman with Takayasu’s arteritis (TAK), a large vessel vasculitis involving large and medium pulmonary arteries in about 50 percent of cases. (A, B) TAK typically involves the aorta, seen here with contrast-enhanced CT of the chest. Note circumferential thickening of the walls of the descending thoracic and upper abdominal aorta (arrows). (C) Left pulmonary artery involvement in TAK, shown in CT image at level of the left atrial appendage. Occlusion of the lingular branch present (arrow). (D) A coronal MR angiography image in the same patient demonstrates a perfusion defect in the lingual secondary to lingular branch occlusion (arrows).

Images and some captions are republished with permission from an article published in Radiologic Clinics of North America. Authors include Shamseldeen Mahmoud, MD, a nuclear radiology fellow; Carol Farver, MD, Director of Pulmonary Pathology; and Joseph Azok, MD, Subha Ghosh, MD, Jason Lempel, MD, and Rahul Renapurkar, MD, all staff in the Imaging Institute.