PMC4956902_01
(A) Chest radiograph (posteroanterior view) reveals right mid lung zone mass (arrow) and multiple pulmonary nodules (arrows) in left lung. (B) Chest computed tomography in axial plane, in lung window, confirms presence of right middle lobe mass (white arrow), with well defined borders, lobulated outline and cavitation (black arrow).
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A computed tomography (CT) scan showed a 6 cm mass-like area of consolidation with small cavities in the right middle lobe, and well defined solid nodules in the periphery of the left lower lobe (Fig. 1).
The image shows extensive mixed type necrosis with a focal rounded area of suppurative necrosis on the left side (dashed line) (H&E stain, 100x). The elastic stain in the inset highlights, in black, the elastic layer of the blood vessel wall, which is partially destroyed (arrows) by the inflammation (Verhoeff stain, 200x).
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This constellation of features was diagnostic of granulomatosis with polyangiitis (GPA) (Fig. 2).
Follow up chest radiograph (posteroanterior view) performed following treatment, demonstrates significant decrease in size of largest lesion in mid lung zone (white arrow).
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On repeat chest radiograph four weeks after treatment, there was interval improvement in the airspace disease density (Fig. 3).