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Air trapping in Wegener’s granulomatosis: an additional finding on expiratory chest HRCT

L’intrappolamento d’aria nella granulomatosi di Wegener: un reperto integrativo nella HRCT eseguita in espirazione

  • Chest Radiology / Radiologia Toracica
  • Published:
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Abstract

Purpose

This study was undertaken to assess the presence and extent of air trapping (AT) on high-resolution computed tomography (HRCT) in patients with Wegener’s granulomatosis (WG) and to correlate the finding with the inspiratory pattern and bronchial/bronchiolar involvement.

Materials and methods

Twenty-one patients (7 M/14 F) with WG underwent inspiratory and expiratory HRCT. Images were evaluated for the presence and extent of AT and for airway involvement (bronchi/bronchioles); the predominant HRCT pattern was also documented. The attenuation difference was measured between the areas of AT on expiration and the same areas on inspiration in order to verify the finding of AT. The extent of AT was calculated by visual scoring and correlated with the predominant inspiratory patterns and bronchial/bronchiolar involvement.

Results

AT was found in seven patients (33.3%) and its extent ranged between 3% and 70% (mean 15.8±7). Two patients showed no lesions on inspiratory HRCT, and the only finding was AT on expiration. The attenuation difference between areas of AT on expiration and the same areas on inspiration ranged between 32 and 89 HU. Inspiratory HRCT was pathological in 19 patients (90.4%), and the principal lung patterns were nodular, cavitary or noncavitary (n=7, 38.9%); ground-glass opacities (n=5, 26.3%); masses (n=3, 15.8%); fibrotic (n=3, 15.8%); and consolidation with air bronchogram (n=1, 5.3%). Bronchial and bronchiolar involvement was found in 14 and five patients, respectively. No statistically significant correlation was found between AT extent and the findings on inspiration. In addition, there were no specific patterns that caused higher or lower scores of AT. Moreover, when bronchial or bronchiolar involvement was absent, the mean AT score was statistically significantly higher.

Conclusions

Areas of AT represent a new and indirect HRCT finding, — and in rare cases the only finding — of pulmonary WG. The nonsignificant correlation between AT extent and inspiratory findings may suggest AT as an additional HRCT finding in patients with WG.

Riassunto

Obiettivo

Scopo di questo studio è quello di valutare la presenza e l’estensione dell’intrappolamento d’aria nella granulomatosi di Wegener (GW) attraverso l’utilizzo della tomografia computerizzata ad alta risoluzione (HRCT) e correlare con i reperti inspiratori ed il coinvolgimento bronchiale/bronchiolare.

Materiali e metodi

21 pazienti (7M/14F) affetti da WG sono stati esaminati con HRCT in fase inspiratoria ed espiratoria. Le immagini sono state valutate per la presenza e l’estensione di intrappolamento d’aria, per il coinvolgimento delle vie aeree (bronchi/bronchioli) ed il modello HRCT dominante. È stata misurata la differenza di attenuazione tra le regioni di intrappolamento d’aria e le corrispondenti regioni in inspirazione per poter verificare la presenza di intrappolamento d’aria. L’estensione di intrappolamento d’aria è stata calcolata con calcolo visuale (visual scoring) e correlata con il modello inspiratorio dominante e il coinvolgimento bronchiale/bronchiolare.

Risultati

L’intrappolamento d’aria è stato identificato in 7 (33,3%) e la sua estensione era tra il 3% ed il 70% (15,8±7). Due dei pazienti non avevano presentato dei reperti in fase inspiratoria ed il loro unico reperto era l’intrappolamento d’aria in fase espiratoria. La differenza di attenuazione tra le regioni d’intrappolamento d’aria in espirazione e le stesse regioni in inspirazione aveva un range compreso tra 32 e 89 unità di Hounsfield (HU). La TC ad alta risoluzione era patologica in 19 pazienti (90,4%) e rappresentata dai seguenti modelli polmonari principali: nodulare, cavitario/non cavitario (n=7, 38,9%), opacità a vetro smerigliato (GGO) (n=5, 26,3%), masse (n=3, 15,8%), modello fibrotico (n=3, 15,8%) e consolidativo con broncogramma aereo (n=1, 5,3%). Il coinvolgimento dei bronchi e bronchioli è stato riscontrato in 14 e 5 pazienti rispettivamente. Non è stata rilevata una correlazione statisticamente significativa tra l’estensione dell’intrappolamento d’aria ed i reperti in fase inspiratoria. Inoltre, non ci sono dei modelli specifici che possono causare dei livelli alti o bassi d’intrappolamento d’aria. Per di più, quando il coinvolgimento bronchiale o bronchiolare è assente il valore medio dei livelli d’intrappolamento d’aria è statisticamente e significativamente più elevato.

Conclusioni

Le regioni d’intrappolamento d’aria nella granulomatosi di Wegener, rappresentano un nuovo reperto, indiretto e probabilmente, in rari casi, l’unico reperto di coinvolgimento polmonare rilevato in TC ad alta risoluzione. La correlazione non statisticamente significativa tra l’estensione dell’intrappolamento d’aria ed i reperti in fase inspiratoria possono suggerire l’intrappolamento d’aria come un ulteriore reperto nella TC ad alta risoluzione in pazienti con granulomatosi di Wegener.

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Authors and Affiliations

  1. Department of Radiology, University Hospital of Heraklion, Medical School of Crete, 71110 Stavrakia, Heraklion, Crete, Greece

    E. Magkanas, E. Detorakis, I. Nikolakopoulos, S. Gourtsoyianni & N. Gourtsoyiannis

  2. Department of Rheumatology, University Hospital of Heraklion, Medical School of Crete, Heraklion, Crete, Greece

    P. Sidiropoulos & D. Boumpas

  3. Department of Preschool Education, University of Crete, Crete, Greece

    M. Linardakis

  4. 1 Tsakiri St., 71202, Heraklion, Crete, Greece

    E. Magkanas

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  1. E. Magkanas
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  2. E. Detorakis
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Correspondence to E. Magkanas or E. Detorakis.

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Magkanas, E., Detorakis, E., Nikolakopoulos, I. et al. Air trapping in Wegener’s granulomatosis: an additional finding on expiratory chest HRCT. Radiol med 116, 858–867 (2011). https://doi.org/10.1007/s11547-011-0675-8

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  • DOI: https://doi.org/10.1007/s11547-011-0675-8

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