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Granulomatosis with polyangiitis

Case contributed by Stefan Tigges
Diagnosis almost certain

Presentation

Cough and hemoptysis.

Patient Data

Age: 50 years.
Gender: Male
x-ray

Multiple thick-walled cavities in both lungs.

CT confirms multiple irregular thick-walled pulmonary cavities. There is nodular thickening of the right main bronchus and bronchus intermedius with circumferential thickening of the left main bronchus. Calcified mediastinal and left hilar lymph nodes are likely unrelated and secondary to prior tuberculosis or histoplasmosis infection.

Case Discussion

Multiple pulmonary cavities are most often due to infection or metastatic disease, but the airway thickening seen on CT in this case makes granulomatosis with polyangiitis more likely.

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