Imaging Pearls ❯ Chest ❯ Vasculitis
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- "ACS is one of the most common pulmonary manifestations of SCD and, as in other complications, is attributed to tissue ischemia from microvascular occlusion, precipitated by deox- ygenated states. Although the inciting mechanism for ACS is incompletely understood, conditions that have been associated with predisposition to ACS in SCD include pneumonia, fat emboli originating from infarcted bone marrow, and pulmo- nary infarction mediated by vascular occlusion from deep ve- nous thrombosis/pulmonary embolism. The diagnosis of ACS requires both an acute pulmonary illness, clinically characterized by anemia, fever, chest pain, cough, dyspnea, tachypnea, tachycardia, or cyanosis, and the presence of a new pulmonary opacity or consolidation involving at least one complete lung segment on radiograph or computed tomography (CT).”
Imaging review of sickle cell disease for the emergency radiologist
Shenise N. Gilyard et al.
Emergency Radiology (2021) 28:153–164 - "Of note, 30–60% of patients who are subsequently diagnosed with ACS will not have an imaging abnormality on initial presentation but will develop an airspace opacity on follow-up imaging. Due to effective immune compromise from autosplenectomy in this population, sickle cell patients are especially predisposed to pneumonia (especially encapsulated organisms) as compared with the general population. Consequently, it is often difficult to confidently exclude pneumonia on the basis of imaging alone when a new lung opacity is identified.”
Imaging review of sickle cell disease for the emergency radiologist
Shenise N. Gilyard et al.
Emergency Radiology (2021) 28:153–164 - “Cardiomyopathy is common in SCD and is multifactorial in etiology, often related to high-output heart failure in the set- ting of chronic anemia, iron overload, and additional volume overload related to renal insufficiency. Pulmonary hypertension can lead to left heart failure and cor pulmonale. Additionally, myocardial fibrosis related to chronic microvascular occlusion contributes to diastolic dysfunction and further impairment of cardiac function. Cardiac and left atrial enlargement can easily be identified on chest radiographs and CT. Contrast-enhanced CT of the chest may reveal myocardial thinning in areas of previous myocardial infarction, reported in 7–30% of SCD patients. Myocardial fibrosis is best evaluated with cardiac MRI, although it is typically not uti- lized in the emergent setting.”
Imaging review of sickle cell disease for the emergency radiologist
Shenise N. Gilyard et al.
Emergency Radiology (2021) 28:153–164
- Wegener Granulomatosis: Facts
- Necrotizing vasculitis that involves small to medium vessels
- May involve ear, nose, throat, lung or kidneys
- Clinical presentation ranges from sinusitis to cough, fever, wheezing to hematuria - Wegener Granulomatosis: Facts
- Upper airways involved in up to 92% of cases, renal in 80% and joints in 67%
- Age at dx usually 40-55 yrs
- M=F but females have airway problems more commonly
- Treatment with steroids and cyclophosphamide - Wegener Granulomatosis: Chest
- Cavitary nodules
- Large airway stenosis
- Nodules 1-10 cm in size
- Consolidation with or w/o hemorrhage
- Subglottic stenosis
- Adenopathy uncommon