CTICasesGranulomatosis with Polyangiitis (GPA)
Imaging findings
A young man in his late teens with fever, weight loss, and cough had a radiograph and CT showing a right upper lobe mass with cavitation, thick irregular walls, internal debris without a true fluid level, and additional randomly distributed well-defined nodules (some also cavitary, "cheerio" sign). He also had sinusitis with epistaxis and was found to have an abnormal BUN/creatinine with glomerulonephritis on workup, and biopsy confirmed necrotizing vasculitis and necrosis consistent with granulomatosis with polyangiitis (GPA); the airways were notably spared without endobronchial involvement.
Key takeaways
Multiple thick-walled cavitary lung nodules of varying size in a young patient with sinonasal symptoms and renal impairment (pulmonary-renal syndrome) should prompt evaluation for granulomatosis with polyangiitis, and the imaging appearance evolves from smaller well-formed nodules to larger cavitating masses as necrotizing vasculitis progresses; airway involvement, while classically described in GPA, was absent in this case and appears to be observed less frequently in more recent experience.
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