Limits...
Wegener Granulomatosis

Sutcliffe JBS - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Brooke Army Medical Center

ABSTRACT

Diagnosis: Wegener Granulomatosis

History: Patient presented with a 2 month history of increasing inspiratory and expiratory stridor which began after 2 separate sinus surgeries. Pertinent history is that the patient experienced her first episode of epistaxis several years prior to surgery and had multiple subsequent clinical visits for sinusitis. She also has a remote history of migratory arthralgias/joint effusions/fevers and ulcerative colitis (diagnosed by colonscopy).

Findings: Image 1: AP neck radiographic demonstrates subglottic narrowing and loss of subglottic shouldering. Image 2: Lateral neck radiograph demonstrates subglottic narrowing and posterior tracheal mucosal thickening and irregularity. Image 3: Same as 2 with arrows and explanation. Image 4: Axial CT demonstrates marked narrowing of the subglottic trachea with prominent paratracheal soft tissue thickening. Image 5: Axial CT slightly lower than image 4 demonstrates a blind fistulus tract arising anterior right aspect of the subglottic trachea just inferior to the level of the stenosis. Images 6,7: Demonstrate maxillary and ethmoidal sinus mucosal thickening. Images 8,9: virtual bronchoscopy images demonstrate laryngeal anatomy and the area of stenosis seen below the cords. Images 10,11: virtual bronchoscopy images slightly inferior than the prior images demonstrate the false cords, true cords, and stenotic segment. Images 12,13: Reverse virtual bronchoscopy images (looking from the trachea toward the larynx) at the exact level of the tracheal pathology demonstrate mucosal thickening and irregularity with the opening of a fistulus tract along the right anterior trachea.

Ddx: Intubation trauma causing subglottic stenosis Acute bacterial tracheatis Wegener's granulomatosis Neoplastic disease (lymphoma, etc)

Dxhow: proteinase 3AB c-antineutrophil cytoplasmic antibody (c-ANCA) was elevated to 1.66 (normal less than 0.8) and is highly specific (99%) for Wegener granulomatosis

Exam: Physical exam demonstrated a petite female (wt 45 kg) with a low pitched inspiratory and expiratory stridor audible across the room. She was afebrile but tachypneic. Spirometry demonstrated complete flattening of the inspiratory and expiratory loops. ESR elevated at 82, HCT low at 29.4, RF elevated at 80, ANA neg, LFT's WNL, CHEM 7 WNL, proteinase 3AB c-ANCA elevated at 1.66.

No MeSH data available.


This virtual bronchoscopy image is a software reconstruction of raw CT data from the patient. Can you identify the major structures in the image?
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=MPX1442&req=5

MPX1442_synpic18721: This virtual bronchoscopy image is a software reconstruction of raw CT data from the patient. Can you identify the major structures in the image?


Wegener Granulomatosis

Sutcliffe JBS - MedPix

This virtual bronchoscopy image is a software reconstruction of raw CT data from the patient. Can you identify the major structures in the image?
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1442&req=5

MPX1442_synpic18721: This virtual bronchoscopy image is a software reconstruction of raw CT data from the patient. Can you identify the major structures in the image?

View Article: MedPix Image - MedPix Case

Affiliation: Brooke Army Medical Center

ABSTRACT

Diagnosis: Wegener Granulomatosis

History: Patient presented with a 2 month history of increasing inspiratory and expiratory stridor which began after 2 separate sinus surgeries. Pertinent history is that the patient experienced her first episode of epistaxis several years prior to surgery and had multiple subsequent clinical visits for sinusitis. She also has a remote history of migratory arthralgias/joint effusions/fevers and ulcerative colitis (diagnosed by colonscopy).

Findings: Image 1: AP neck radiographic demonstrates subglottic narrowing and loss of subglottic shouldering. Image 2: Lateral neck radiograph demonstrates subglottic narrowing and posterior tracheal mucosal thickening and irregularity. Image 3: Same as 2 with arrows and explanation. Image 4: Axial CT demonstrates marked narrowing of the subglottic trachea with prominent paratracheal soft tissue thickening. Image 5: Axial CT slightly lower than image 4 demonstrates a blind fistulus tract arising anterior right aspect of the subglottic trachea just inferior to the level of the stenosis. Images 6,7: Demonstrate maxillary and ethmoidal sinus mucosal thickening. Images 8,9: virtual bronchoscopy images demonstrate laryngeal anatomy and the area of stenosis seen below the cords. Images 10,11: virtual bronchoscopy images slightly inferior than the prior images demonstrate the false cords, true cords, and stenotic segment. Images 12,13: Reverse virtual bronchoscopy images (looking from the trachea toward the larynx) at the exact level of the tracheal pathology demonstrate mucosal thickening and irregularity with the opening of a fistulus tract along the right anterior trachea.

Ddx: Intubation trauma causing subglottic stenosis Acute bacterial tracheatis Wegener's granulomatosis Neoplastic disease (lymphoma, etc)

Dxhow: proteinase 3AB c-antineutrophil cytoplasmic antibody (c-ANCA) was elevated to 1.66 (normal less than 0.8) and is highly specific (99%) for Wegener granulomatosis

Exam: Physical exam demonstrated a petite female (wt 45 kg) with a low pitched inspiratory and expiratory stridor audible across the room. She was afebrile but tachypneic. Spirometry demonstrated complete flattening of the inspiratory and expiratory loops. ESR elevated at 82, HCT low at 29.4, RF elevated at 80, ANA neg, LFT's WNL, CHEM 7 WNL, proteinase 3AB c-ANCA elevated at 1.66.

No MeSH data available.