CTICasesMicroscopic Polyangiitis
Imaging findings
Chest radiographs and CT in a diabetic patient presenting with hemoptysis and acute renal failure show diffuse, bilateral consolidative and ground-glass opacities with subpleural sparing, representing diffuse alveolar hemorrhage. The patient is ANCA positive with high titers of myeloperoxidase (MPO) antibodies. Renal biopsy confirms glomerulonephritis without vasculitis.
Key takeaways
Microscopic polyangiitis (MPA) is a necrotizing systemic vasculitis that predominantly affects small vessels (capillaries, venules, arterioles). It is strongly associated with MPO-ANCA. The classic pulmonary manifestation is diffuse alveolar hemorrhage secondary to pulmonary capillaritis, which presents as ground-glass opacities and consolidation on CT. Treatment involves aggressive immunosuppressive therapy with corticosteroids and cyclophosphamide or rituximab.
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