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Gozzi L, Cozzi D, Zantonelli G, Giannessi C, Giovannelli S, Smorchkova O, Grazzini G, Bertelli E, Bindi A, Moroni C, Cavigli E, Miele V. Lung Involvement in Pulmonary Vasculitis: A Radiological Review. Diagnostics (Basel) 2024; 14:1416. [PMID: 39001306 PMCID: PMC11240918 DOI: 10.3390/diagnostics14131416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
Pulmonary vasculitis identifies a heterogeneous group of diseases characterized by inflammation, damage and necrosis of the wall of pulmonary vessels. The most common approach to classify vasculitis is according to etiology, therefore dividing them into primary and secondary, with a further sub-classification of primary vasculitis based on the size of the affected vessels (large, medium, and small). Pulmonary involvement is frequently observed in patients with systemic vasculitis and radiological presentation is not pathognomonic, but may vary between diseases. The main findings using high-resolution computed tomography (HRCT) include small vessel wall thickening, nodular lesions, cavitary lesions, reticular opacities, ground-glass opacities (GGO), consolidations, interlobular septal thickening, tracheobronchial stenosis, and aneurysmal dilatation of pulmonary arteries, with or without pleural effusion. Radiological diagnosis alone is difficult since signs and symptoms of lung vessel involvement are often non-specific and might overlap with other conditions such as infections, connective tissue diseases and neoplasms. Therefore, the aim of this review is to describe the most common radiological features of lung involvement in pulmonary vasculitis so that, alongside detailed clinical history and laboratory tests, a prompt diagnosis can be performed.
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Affiliation(s)
- Luca Gozzi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Giulia Zantonelli
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Caterina Giannessi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Simona Giovannelli
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Olga Smorchkova
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Giulia Grazzini
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Bertelli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandra Bindi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Moroni
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
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Kimbrough BA, Baqir M, Johnson TF, Vasireddy A, Ryu JH. Interstitial Lung Disease in Giant Cell Arteritis: Review of 23 Patients. J Clin Rheumatol 2022; 28:e3-e8. [PMID: 32925448 DOI: 10.1097/rhu.0000000000001566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Giant cell arteritis (GCA) is a large-vessel vasculitis with systemic manifestations. A few case reports have described a possible association of GCA with interstitial lung disease (ILD). The primary aim of the present study was to describe the pattern, severity, and course of ILD in patients with GCA. METHODS This medical records review study evaluated adult patients presenting to Mayo Clinic in Rochester, MN, from January 1, 1997, through December 31, 2018, who had the diagnoses of GCA and ILD. Clinical, laboratory, and radiologic data were analyzed. RESULTS In total, 23 patients were in the study. Median (range) age was 78 (58-93) years, and 14 (61%) were women. Six patients (26%) had a cough at GCA diagnosis. At ILD diagnosis, 15 patients had respiratory symptoms, including dyspnea (n = 12, 52%), dry cough (n = 6, 26%), wheezing (n = 1, 4%), and chest pain (n = 1, 4%). On initial chest computed tomography, the most common pattern of ILD was probable usual interstitial pneumonia (n = 7, 30%), indeterminate for usual interstitial pneumonia (n = 5, 22%), and combined pulmonary fibrosis and emphysema (n = 3, 13%). Airway abnormalities were present in 10 patients: 6 with bronchial wall thickening, 2 with bronchiectasis, and 2 with both. At follow-up computed tomography, 8 patients had ILD progression. Three patients with cough improved after initiation of glucocorticoid therapy. CONCLUSIONS Interstitial lung disease and airway abnormalities may be associated with GCA. Although cough may improve, ILD in some patients with GCA may progress despite immunosuppressive therapy.
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Affiliation(s)
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine
| | | | - Amit Vasireddy
- Department of Internal Medicine, Berkshire Medical Center, Pittsfield, MA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine
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Abstract
Purpose of Review Giant cell arteritis (GCA), a medium and large vessel vasculitis occurring in the aged, remains a formidable disease, capable of taking both vision and life, through a multitude of vascular complications. Our understanding of the spectrum of its manifestations has grown over the years, to include limb claudication, aortitis, and cardiac disease, in addition to the more classic visual complications resulting from of ischemia to branches of the external and internal carotid arteries. While a clinical presentation of headache, jaw claudication, scalp tenderness, fever and other systemic symptoms and serum markers are together highly suggestive of the disease, diagnosis can be challenging in those cases in which classic symptoms are lacking. The purpose of this review is to update the reader on advances in the diagnosis and treatment of giant cell arteritis and to review our evolving understanding of the immunological mechanism underlying the disease, which have helped guide our search for novel therapies. Recent Findings There is increasing evidence supporting the use of Doppler ultrasound, dedicated post-contrast T1-weighted spin echo MRI of the scalp arteries and PET scan, which can together improve our diagnostic accuracy in cases in which temporal artery biopsy is either inconclusive or not feasible. Advances in our understanding of the immunological cascades underlying the disease have helped guide our search for steroid-sparing treatments for the GCA, the most important of which has been the IL-6 receptor antibody inhibitor tocilizumab, which has been shown to reduce cumulative steroid dose in a large multicenter, placebo-controlled prospective study. Other biologic agents, such as abatacept and ustekinumab have shown promise in smaller studies. Summary GCA is no longer a disease whose diagnosis is based exclusively on temporal artery biopsy and whose complications are prevented solely with the use of corticosteroids. Modern vascular imaging techniques and targeted immunologic therapies are heralding a new era for the disease, in which practitioners will hopefully be able to diagnosis it with greater accuracy and treat it with less ischemic complications and iatrogenic side effects.
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Perruzza M, Fusha E, Cameli P, Capecchi PL, Selvi E, Gentili F, Mazzei MA, Aversa S, Spina D, Di Lucia D, Sestini P, Luzzi L, Bargagli E. Pleuroparenchymal fibroelastosis (PPFE) associated with giant cell arteritis: A coincidence or a novel phenotype? Respir Med Case Rep 2019; 27:100843. [PMID: 31024793 PMCID: PMC6476809 DOI: 10.1016/j.rmcr.2019.100843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/16/2022] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a rare interstitial lung disease characterized by the fibrotic thickening of subpleural and parenchymal areas of the upper lobes. It may be both idiopathic or secondary to infections, interstitial lung diseases and/or drug exposure. Often PPFE patients report recurrent lower respiratory tract infections, suggesting that repeated inflammatory alterations induced by pulmonary infections may contribute to the development/progression of PPFE. Here, we report for the first time the case of a patient affected by Giant cell Arteritis with histologically proven PPFE. The lung involvement in GCA is rare and interstitial lung diseases are usually reported as an uncommon clinical manifestation of GCA. Our patient is probably the first case presenting PPFE associated with GCA and we wonder if this is a real associative disease or a coincidence perhaps, secondary to drug effects.
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Affiliation(s)
- M Perruzza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - E Fusha
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - P Cameli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - P L Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - E Selvi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - F Gentili
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - M A Mazzei
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - S Aversa
- Pathology Section, Department of Human Pathology and Oncology, Siena University Hospital, Siena, Italy
| | - D Spina
- Pathology Section, Department of Human Pathology and Oncology, Siena University Hospital, Siena, Italy
| | - D Di Lucia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - P Sestini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - L Luzzi
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Siena University Hospital, Italy
| | - E Bargagli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
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Adams TN, Zhang D, Batra K, Fitzgerald JE. Pulmonary manifestations of large, medium, and variable vessel vasculitis. Respir Med 2018; 145:182-191. [PMID: 30509707 DOI: 10.1016/j.rmed.2018.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/14/2018] [Accepted: 11/06/2018] [Indexed: 02/01/2023]
Abstract
The hallmark of vasculitis is autoimmune inflammation of blood vessels and surrounding tissues, resulting in an array of constitutional symptoms and organ damage. The lung is commonly targeted in the more familiar ANCA-associated small vessel vasculitidies, but large and medium vessel vasculitides, including Takayasu arteritis, giant cell arteritis, polyarteritis nodosa, Behcet's disease, and necrotizing sarcoid granulomatosis, may also feature prominent pulmonary involvement. Pulmonary manifestations of these conditions include pulmonary arterial aneurysms, pulmonary hypertension, diffuse alveolar hemorrhage, pulmonary nodules, and parenchymal infiltrates. An understanding of the diverse manifestations of vasculitis and a high index of clinical suspicion are essential to avoid delays in disease recognition that may result in permanent or life threatening morbidity. In this review, we outline the general clinical manifestations, pulmonary manifestations, diagnostic workup, imaging findings, and treatment of medium, large, and variable vessel vasculitides.
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Affiliation(s)
- Traci N Adams
- University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States.
| | - Da Zhang
- University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States
| | - Kiran Batra
- University of Texas Southwestern Medical Center, Department of Radiology, United States
| | - John E Fitzgerald
- University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States
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