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Chest CT findings in pediatric Wegener's granulomatosis
Daniel Levine1, Jonathan Akikusa, David Manson
1Department of Radiology and Nuclear Medicine, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, Canada V6H 3V4. daniel.levine@mac.com
Insights
Chest CT scans reveal frequent abnormalities in active pediatric Wegener's granulomatosis (pWG), primarily nodules and ground-glass opacities. These findings, often missed on plain X-rays, support routine CT use in pediatric patients with WG.
Area of Science:
- Pediatric Rheumatology
- Radiology
- Pulmonology
Background:
- Pulmonary involvement is common in pediatric Wegener's granulomatosis (pWG).
- Limited data exists on CT imaging findings in pediatric patients with WG.
Purpose of the Study:
- To determine the frequency and types of chest CT abnormalities in active pediatric WG (pWG).
Main Methods:
- Retrospective review of 29 chest CT examinations in 18 children with pWG.
- Examinations were performed at diagnosis (n=14) and during disease flares (n=15).
Main Results:
- Nodules were the most common abnormality (90%), followed by ground-glass opacification (52%) and air-space opacification (45%).
- Air-space opacification was significantly more prevalent at diagnosis (71%) than during flares (20%).
- Cavitary lesions were present in 17% of examinations.
Conclusions:
- Chest CT abnormalities are frequent in active pWG, predominantly nodules and ground-glass opacities.
- These findings may be subtle and difficult to detect on plain radiography.
- Routine chest CT is recommended for pediatric WG patients at presentation and during flares.
Background:
Although pulmonary involvement occurs in the majority of children and adolescents with Wegener's granulomatosis (WG), relatively little has been published regarding the CT imaging manifestations in this group of patients.
Objective:
To determine the frequency and types of chest CT abnormalities in active pediatric WG (pWG).
Materials And Methods:
The study was a retrospective examination of 29 chest CT examinations performed at diagnosis (n=14) and during disease flares (n=15) in 18 children.
Results:
The most common abnormalities were nodules (seen in 90% of examinations), ground-glass opacification (52%), and air-space opacification (45%). Of examinations with nodules, 73% demonstrated nodules >5 mm in diameter and 69% demonstrated more than five nodules; 17% had cavitary lesions. The only abnormality with a significant difference in prevalence between diagnosis and disease flares was air-space opacification, present in 71% and 20%, respectively (P < 0.01).
Conclusions:
In accordance with the findings of published adult studies and at variance with those of prior pediatric studies, our findings indicate that chest CT abnormalities in active pWG are frequent, most commonly comprising nodules and ground-glass opacification, which may be difficult to detect on plain radiography. We therefore advocate the routine use of chest CT for all affected patients, both at the time of presentation and during disease flares.
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