CTICasesGranulomatosis with Polyangiitis
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Imaging findings
Chest CT demonstrates extensive, bilateral, poorly-marginated peribronchovascular consolidations and masses, with multiple areas of internal cavitation and associated diffuse alveolar hemorrhage. Serum proteinase 3 (PR3) levels are significantly elevated.
Key takeaways
Granulomatosis with polyangiitis (GPA) can occasionally present in an ICU setting with a highly aggressive, necrotizing vasculitis pattern. While multiple nodules or masses are classic, a dense peribronchovascular consolidation pattern with rapid cavitation and diffuse alveolar hemorrhage is a rare but well-described presentation of severe active disease that requires urgent immunosuppressive therapy.
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