Dorsal prevertebral lesions in Wegener granulomatosis: report on four cases.
Retroperitoneal fibrosis has been reported in several patients with Wegener granulomatosis (WG), but only three isolated cases of dorsal prevertebral lesions, closely resembling fibrosing mediastinitis, have been published so far. We describe four new WG patients (two men, two women), 49-59 years old at diagnosis, with dorsal prevertebral lesions, mainly right-sided, and with adjacent pleural thickening in two. These lesions were detected on computed-tomography scans at diagnosis in two patients, and occurred later in the two others. Only one of them had mild back pain. Two patients' lesions were biopsied, revealing granulomatous inflammation. In one patient, the lesion regressed under WG treatment. Lesion size did not change in the remainings. Intralesional calcifications appeared in two. None of the patients had local bone erosion, vascular or neurological complications. These prevertebral lesions might represent a dorsal form of retroperitoneal fibrosis in WG, but usually with a more benign presentation and course. WG should be included in the differential diagnosis of fibrosing mediastinitis (with tuberculosis, neoplastic diseases, sarcoidosis, histiocytosis and inflammatory pseudotumor), which may have a similar radiological appearance.
Barreto
Paulo
P
Department of Internal Medicine, National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, Université Paris Descartes, 27, rue du Faubourg Saint-Jacques, 75879 Paris cedex 14, France.
Pagnoux
Christian
C
Luca
Luminata
L
Aouizerate
Jessie
J
Ortigueira
Isabel
I
Cohen
Pascal
P
Muller
Géraldine
G
Guillevin
Loïc
L
D014890:Granulomatosis with Polyangiitis / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D012185:Retroperitoneal Fibrosis / Q000000981:diagnostic imaging* / Q000473:pathology; D012598:Sclerosis / Q000000981:diagnostic imaging / Q000473:pathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed