CTICasesDiffuse Bronchial Wall Thickening from Granulomatosis with Polyangiitis
Imaging findings
A 63-year-old man with cough, wheeze, and dyspnea has a subtly abnormal frontal chest radiograph but a clearly abnormal lateral view showing thickening of the posterior wall of the bronchus intermedius. CT shows extensive, diffuse, bilateral bronchial wall thickening with a shaggy contour that nearly obliterates the airway lumens in places, extending beyond the mucosa and sparing the more distal lung bases; the trachea itself is relatively spared.
Key takeaways
Diffuse shaggy bronchial wall thickening with luminal narrowing, in a patient with elevated PR3-ANCA and renal involvement, represents an uncommon diffuse airway-predominant presentation of granulomatosis with polyangiitis (GPA) rather than the more typical tracheal/subglottic-limited disease; the lateral radiograph's posterior bronchus-intermedius wall thickening is a valuable clue that is easy to miss on the frontal view alone.
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