CTICasesGranulomatosis with Polyangiitis (GPA) with Tracheobronchial and Nodular Involvement
Imaging findings
Chest CT shows multiple well-defined and ill-defined pulmonary nodules of varying sizes throughout both lungs, some containing air bronchograms. Additionally, there is marked, circumferential thickening of the central airway walls, particularly involving the posterior membrane of the trachea and the main/lobar bronchi, resulting in focal narrowing of the upper lobe bronchus.
Key takeaways
Tracheobronchial airway involvement is a well-recognized but underappreciated manifestation of granulomatosis with polyangiitis (GPA) that can lead to significant airway stenosis and inflammation. Highly elevated anti-proteinase 3 (anti-PR3) antibodies, combined with the presence of multiple pulmonary nodules and diffuse central airway wall thickening, strongly support GPA over infectious or other inflammatory etiologies.
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