CTICasesIgG4-Related Disease Presenting as Tracheal Wall Thickening with Nodular Consolidation
Imaging findings
A patient with recurrent infections and persistent pulmonary nodules and consolidation, predominantly in the lower lobes, has serial CTs showing progressive circumferential tracheal wall thickening with relative sparing of the posterior membrane, plus narrowing of the right middle lobe bronchus; a wedge resection of lung (not trachea) stained strongly positive for IgG4-bearing plasma cells.
Key takeaways
Circumferential tracheal wall thickening sparing the posterior membrane, together with IgG4-positive lung tissue on biopsy, raises consideration for IgG4-related tracheobronchial disease even without a tissue diagnosis directly from the trachea itself; the imaging appearance can otherwise mimic relapsing polychondritis, granulomatous infection (such as TB or coccidioidomycosis), or amyloidosis.
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