Granulomatosis with polyangiitis differential diagnosis: Difference between revisions
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*Renal symptoms, [[hematuria]], red cell [[casts]] | *Renal symptoms, [[hematuria]], red cell [[casts]] | ||
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*Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR | *Pulmonary nodules with cavities and infiltrates are a frequent manifestation on [[Chest X-ray|CXR]] | ||
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*CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung | *CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung | ||
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*[[Sputum]] smear positive for [[acid-fast bacilli]] | *[[Sputum]] smear positive for [[acid-fast bacilli]] | ||
*Nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid . | |||
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*Pulmonary nodules with cavitation are located in the upper lobe ([[Caplan syndrome]]) on Xray. | *Pulmonary nodules with cavitation are located in the upper lobe ([[Caplan syndrome]]) on Xray. | ||
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*Positive for both [[rheumatoid factor]] and anticyclic citrullinated peptide [[Antibody|antibody.]] | *Positive for both [[rheumatoid factor]] and anticyclic citrullinated peptide [[Antibody|antibody.]] | ||
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*[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies | *[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies | ||
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*On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen. | *On CXR, bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen. | ||
*CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy | *CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy | ||
*Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.<ref name="pmid2748828">{{cite journal |vauthors=Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H |title=Pulmonary sarcoidosis: evaluation with high-resolution CT |journal=Radiology |volume=172 |issue=2 |pages=467–71 |year=1989 |pmid=2748828 |doi=10.1148/radiology.172.2.2748828 |url=}}</ref> | *Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.<ref name="pmid2748828">{{cite journal |vauthors=Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H |title=Pulmonary sarcoidosis: evaluation with high-resolution CT |journal=Radiology |volume=172 |issue=2 |pages=467–71 |year=1989 |pmid=2748828 |doi=10.1148/radiology.172.2.2748828 |url=}}</ref> | ||
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*Biopsy of lung shows non-[[caseating]] [[granuloma]] | *Biopsy of lung shows non-[[caseating]] [[granuloma]] | ||
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*Biopsy of the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref> | *Biopsy of the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref> | ||
*[[Pulmonary function tests]] demonstrate low | *[[Pulmonary function tests]] demonstrate low FEV1/FVC | ||
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Revision as of 18:23, 27 March 2018
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Granulomatosis with polyangiitis Microchapters |
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Differentiating Granulomatosis with polyangiitis from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3]
Overview
Granulomatosis with polyangiitis must be differentiated from other diseases that cause purpura, alveolar hemorrhage, fever, arthralgia, myalgia, necrotizing extra-capillary glomerulonephritis, such as Microscopic polyangiitis and Eosinophilic granulomatosis with polyangiitis.[1]
Differentiating Granulomatosis with polyangiits from other Diseases
Granulomatosis with polyangiitis must be differentiated from other diseases that cause purpura, alveolar hemorrhage, necrotizing extra-capillary glomerulonephritis, such as Microscopic polyangiitis and Eosinophilic granulomatosis with polyangiitis.[1] [2]
| Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis serological findings | |||
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| Eosinophilic granulomatosis with polyangiitis | Granulomatosis with polyangiitis | Microscopic polyangiitis | |
| Cytoplasmic ANCA (cANCA) | 90% positive | ||
| Perinuclear ANCA (pANCA) | 30 to 40% positive | 60 to 80% positive | |
| Myeloperoxidase antigen | 40% sensitivity | 10% sensitivity | 30% sensitivity |
| Proteinase 3 antigen | <5% sensitivity | 70-80% sensitivity | 60% sensitivity |
Differentiating Granulomatosis with polyangiitis from other Diseases
Granulomatosis with polyangiitis must be differentiated from other diseases that cause purpura, alveolar hemorrhage, fever, arthralgia, myalgia, necrotizing extra-capillary glomerulonephritis and include:[1]
- mononeuritis multiplex
- venous thrombosis
- necrotizing vasculitis of small-sized vessels
- ear nose throat involvement
Differential diagnosis
| Causes of
lung cavities |
Differentiating Features | Differentiating radiological findings | Diagnosis
confirmation |
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References
- ↑ 1.0 1.1 1.2 Pagnoux C (2016). "Updates in ANCA-associated vasculitis". Eur J Rheumatol. 3 (3): 122–133. doi:10.5152/eurjrheum.2015.0043. PMID 27733943.
- ↑ Kallenberg CG, Heeringa P, Stegeman CA (2006). "Mechanisms of Disease: pathogenesis and treatment of ANCA-associated vasculitides". Nat Clin Pract Rheumatol. 2 (12): 661–70. doi:10.1038/ncprheum0355. PMID 17133251.
- ↑ 3.0 3.1 Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
- ↑ Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ (2003). "Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients". Eur Radiol. 13 (1): 43–51. doi:10.1007/s00330-002-1422-2. PMID 12541109.
- ↑ 5.0 5.1 Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362.
- ↑ Mouroux J, Padovani B, Elkaïm D, Richelme H (1996). "Should cavitated bronchopulmonary cancers be considered a separate entity?". Ann. Thorac. Surg. 61 (2): 530–2. doi:10.1016/0003-4975(95)00973-6. PMID 8572761.
- ↑ Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM (2005). "Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome". Radiology. 237 (1): 342–7. doi:10.1148/radiol.2371041650. PMID 16183941.
- ↑ Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R (2001). "Clinical characteristics of patients in a case control study of sarcoidosis". Am. J. Respir. Crit. Care Med. 164 (10 Pt 1): 1885–9. doi:10.1164/ajrccm.164.10.2104046. PMID 11734441.
- ↑ Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H (1989). "Pulmonary sarcoidosis: evaluation with high-resolution CT". Radiology. 172 (2): 467–71. doi:10.1148/radiology.172.2.2748828. PMID 2748828.
- ↑ Murphy J, Schnyder P, Herold C, Flower C (1998). "Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma". Eur Radiol. 8 (7): 1165–9. doi:10.1007/s003300050527. PMID 9724431.
- ↑ 11.0 11.1 Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008). "Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review". Ann Thorac Med. 3 (2): 67–75. doi:10.4103/1817-1737.39641. PMC 2700454. PMID 19561910.
- ↑ Cordier JF, Loire R, Brune J (1989). "Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients". Chest. 96 (5): 999–1004. PMID 2805873.
- ↑ Lee KS, Kullnig P, Hartman TE, Müller NL (1994). "Cryptogenic organizing pneumonia: CT findings in 43 patients". AJR Am J Roentgenol. 162 (3): 543–6. doi:10.2214/ajr.162.3.8109493. PMID 8109493.
- ↑ Suri HS, Yi ES, Nowakowski GS, Vassallo R (2012). "Pulmonary langerhans cell histiocytosis". Orphanet J Rare Dis. 7: 16. doi:10.1186/1750-1172-7-16. PMC 3342091. PMID 22429393.
- ↑ Moore AD, Godwin JD, Müller NL, Naidich DP, Hammar SP, Buschman DL, Takasugi JE, de Carvalho CR (1989). "Pulmonary histiocytosis X: comparison of radiographic and CT findings". Radiology. 172 (1): 249–54. doi:10.1148/radiology.172.1.2787035. PMID 2787035.