E. Pulmonary vasculitis
In the evaluation of the patient, consideration must be given to
pulmonary vasculitis, particularly Wegener’s granulomatosis too.
Wegener’s granulomatosis is a systemic autoimmune disorder characterized
by necrotizing granulomatous inflammation of the respiratory tract,
systemic vasculitis, and glomerulonephritis. Patients may present with
constitutional symptoms such as fever, weight loss, and malaise, along
with respiratory symptoms including hemoptysis, cough, and pleuritic
chest pain. The triad of upper respiratory tract involvement (such as
sinusitis), lower respiratory tract involvement (such as hemoptysis and
pulmonary infiltrates), and glomerulonephritis constitutes the classic
presentation of Wegener’s granulomatosis (21).
On imaging, pulmonary vasculitis, including Wegener’s granulomatosis,
can manifest as multiple nodular opacities, ground-glass opacities, or
consolidations. These findings may be bilateral and involve multiple
lung lobes (22).
Diagnosis of Wegener’s granulomatosis typically involves a combination
of clinical assessment, serological testing (such as anti-neutrophil
cytoplasmic antibodies, or ANCA), imaging studies, and tissue biopsy.
ANCA testing, specifically anti-proteinase 3 (PR3) antibodies, may be
positive in up to 80% of cases, aiding in the diagnosis. Tissue biopsy,
often obtained via bronchoscopy or surgical lung biopsy, is crucial for
confirming the presence of granulomatous inflammation and vasculitis
(23).
A comprehensive diagnostic approach, including serological testing and
tissue biopsy, is essential for accurate diagnosis and appropriate
management of this potentially life-threatening condition.