CTICasesDiffuse Alveolar Hemorrhage secondary to Antiphospholipid Antibody Syndrome
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Imaging findings
Chest radiograph demonstrates diffuse, bilateral nodular opacities with striking subpleural sparing. Chest CT shows diffuse, large, centrilobular ground-glass nodules outlined by spared interlobular septa and subpleural lung parenchyma. Lab work confirms normal anti-GBM and ANCA antibodies, but shows elevated lupus anticoagulant based on a prolonged dilute Russell's Viper Venom time. Lung biopsy performed at the bedside confirms diffuse alveolar hemorrhage.
Key takeaways
Diffuse alveolar hemorrhage is a life-threatening pulmonary manifestation that can be caused by systemic autoimmune conditions, including antiphospholipid antibody syndrome. The imaging pattern typically reveals central-predominant ground-glass nodules or consolidation with subpleural sparing. The dilute Russell's Viper Venom time is a highly specific coagulation test used to confirm the presence of lupus anticoagulant when evaluating for antiphospholipid antibody syndrome.
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