title: Imaging findings of pulmonary granulomatosis with polyangiitis (Wegener's granulomatosis): lesions invading the pulmonary fissure, pleura or diaphragm mimicking malignancy.
abstract: BACKGROUND
  Granulomatosis with polyangiitis (GPA, formerly Wegener's granulomatosis), in which pulmonary involvement often predominates, is a multisystem granulomatous, necrotizing vasculitis that affects small and medium-sized vessels. In this study we evaluated various radiological findings of pulmonary GPA and focused on spiculated pulmonary lesions invading the pulmonary fissure, pleura or diaphragm mimicking malignancy.
  
  
  METHODS
  This retrospective study included 48 patients, aged 28-73 (mean, 47.3) years, who showed either histopathological diagnosis of GPA (n = 39) or elevated levels of the cytoplasmic anti-neutrophilic cytoplasmic antibody serum marker (n = 9) between January 2003 and December 2013. All patients received a chest computed tomography (CT), and the types of pulmonary lesions were defined and evaluated.
  
  
  RESULTS
  Among the 48 patients, 33 had abnormal pulmonary findings on CT. The most commonly detected pulmonary lesion types were nodules and masses (n = 126) observed in 24 patients. Cavitation, necrosis, spiculation and invasion of the fissure, pleura or diaphragm were observed in 14, 9, 10 and 6 patients, respectively. Consolidation was found in 14 patients and thickening of bronchial wall in 8 patients.
  
  
  CONCLUSIONS
  Pulmonary lesion types of GPA have a wide spectrum, potentially mimicking a high number of diseases including malignancy, infection and noninfectious inflammatory diseases. A spiculated lung lesion invading the fissure, pleura or diaphragm is mostly present in malignancy, but it can be also seen in GPA.
authors: Department of Radiology, Bulent Ecevit University School of Medicine, 67100, Zonguldak, Turkey. serkan.guneyli@beun.edu.tr.
authors: Serkan
authors: S
authors: Guneyli
authors: Department of Radiology, Ege University School of Medicine, Izmir, Turkey.
authors: Naim
authors: N
authors: Ceylan
authors: Department of Radiology, Ege University School of Medicine, Izmir, Turkey.
authors: Selen
authors: S
authors: Bayraktaroglu
authors: Department of Internal Medicine, Ege University School of Medicine, Izmir, Turkey.
authors: Sercan
authors: S
authors: Gucenmez
authors: Department of Internal Medicine, Ege University School of Medicine, Izmir, Turkey.
authors: Kenan
authors: K
authors: Aksu
authors: Division of Nuclear Medicine, Egerad Diagnostic Imaging Center, Izmir, Turkey.
authors: Kenan
authors: K
authors: Kocacelebi
authors: Department of Radiology, Mevlana University School of Medicine, Konya, Turkey.
authors: Turker
authors: T
authors: Acar
authors: Department of Radiology, Ege University School of Medicine, Izmir, Turkey.
authors: Recep
authors: R
authors: Savas
authors: Department of Radiology, Ege University School of Medicine, Izmir, Turkey.
authors: Hudaver
authors: H
authors: Alper
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D003964:Diaphragm / Q000000981:diagnostic imaging*; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D008875:Middle Aged; D010994:Pleura / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography; Granulomatous; Invasion; Pulmonary; Vasculitis