Radiologie up2date 2007; 7(2): 115-132
DOI: 10.1055/s-2007-966523
Pulmonale und kardiovaskuläre Radiologie

© Georg Thieme Verlag KG Stuttgart · New York

Pulmonale Manifestationen bei systemischen Vaskulitiden

Pulmonary manifestations from systemic vasculitidesM.  Reuter, M.  Both, A.  Schnabel
Further Information

Publication History

Publication Date:
14 June 2007 (online)

Zusammenfassung

Die pulmonalen Vaskulitiden sind Kleingefäßvaskulitiden und umfassen neben der Wegener-Granulomatose die mikroskopische Polyangiitis und das Churg-Strauss-Syndrom. Die Takayasu-Arteriitis als Großgefäßvaskulitis führt zu Stenosen an den Pulmonalarterien.
Für die Interpretation der radiologischen Befunde sind Kenntnisse des oft mehrphasigen Krankheitsverlaufes und des klinischen Erscheinungsbildes der Lungenmanifestationen hilfreich. Daher vermittelt dieser Artikel neben den radiologischen Befunden im Übersichtsbild und im hochauflösenden CT auch klinische Aspekte der pulmonalen Vaskulitiden. Neben der Bestimmung der Krankheitsausdehnung steht die Festlegung der Krankheitsaktivität im Vordergrund der bildgebenden Diagnostik. In diesem Zusammenhang wird auch auf die Therapieprinzipien eingegangen.

Abstract

Pulmonary vasculitides predominantly involve the small arterioles, capillaries and venules and include Wegener's granulomatosis, microscopic polyangiitis and the Churg-Strauss syndrome. Takayasu's arteriitis is a large vessel disease and may affect the main pulmonary arteries causing stenoses and occlusions.

Knowledge of the natural course of disease and of clinical manifestations of pulmonary disease is helpful for an understanding of imaging findings. For this reason this article gives an overview not only of radiologic findings in chest X-ray and high resolution CT of the lungs but as well of clinical aspects of pulmonary vasculitides. Next to determination of disease extension the determination of disease activity is in the foreground of diagnostic imaging in vasculitides. Within this context principals of immunosuppressive therapy will be recognized.

Literatur

  • 1 Sheikhzadeh A, Tettenborn I, Noohi F, Eftekharzadeh M, Schnabel A. Occlusive thromboaortopathy (Takayasu's disease): Clinical and angiographic features. A brief review of literature.  Angiology. 2002;  53 29-40
  • 2 Reinhold-Keller E, Herlyn K, Wagner-Bastmeyer R. et al . No difference in the incidences of vasculitides between north and south Germany: First results of the German vasculitis register.  Rheumatology. 2002;  41 540-549
  • 3 Hoffman G S, Kerr G S, Leavitt R Y. et al . Wegener granulomatosis: an analysis of 158 patients.  Ann Intern Med. 1992;  116 488-498
  • 4 Reinhold-Keller E, Beuge N, Latza U. et al . An interdisciplinary approach to the care of patients with Wegener's granulomatosis.  Arthritis Rheum. 2000;  43 1021-1032
  • 5 Muhle C, Reinhold-Keller E, Richter C. et al . MRI of the nasal cavity, the paranasal sinuses and orbits in Wegener's granulomatosis.  Eur Radiol. 1997;  7 566-570
  • 6 Schnabel A, Holl-Ulrich K, Dalhoff K. et al . Efficacy of transbronchial biopsy in pulmonary vasculitis.  Eur Respir J. 1997;  10 2738-2743
  • 7 Cordier J F, Valeyre D, Guillevin L. et al . Pulmonary Wegener's granulomatosis.  Chest. 1990;  97 906-912
  • 8 Schnabel A, Reuter M, Müller-Quernheim J, Gross W L. Bronchoalveolar lavage cell profiles in Wegener's granulomatosis.  Respir Med. 1999;  93 498-506
  • 9 Ognibene F P, Shelhamer J H, Hoffman G S. Pneumocystis carinii pneumonia: a major complication of immunosuppressive therapy in patients with Wegener's granulomatosis.  Am J Respir Crit Care Med. 1995;  151 795-799
  • 10 Lohrmann U, Uhl M, Schaefer O. et al . Serial high-resolution computed tomography in patients with Wegener Granulomatosis: Differentiation between active inflammatory and chronic fibrotic lesions.  Acta Radiol. 2005;  46 484-491
  • 11 Lee K S, Kim T S, Fujimoto K. et al . Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients.  Eur Radiol. 2003;  13 43-51
  • 12 Reuter M, Schnabel A, Wesner F. et al . Pulmonary WegenerŽs granulomatosis: Correlation between high-resolution CT findings and clinical scoring of disease activity.  Chest. 1998;  114 500-506
  • 13 Schubert F, Muhle C, Schnabel A. et al . High-Resolution CT (HRCT) der Lunge bei Wegenerscher Granulomatose.  Fortschr Röntgenstr. 1994;  161 19-24
  • 14 Komocsi A, Reuter M, Heller M. et al . Active disease and residual damage in treated Wegener's granulomatosis: An observational study using pulmonary high-resolution computed tomography.  Eur Radiol. 2003;  13 36-42
  • 15 Yoshikawa Y, Watanabe T. Pulmonary lesions in Wegener's granulomatosis: a clinicopathologic study of 22 autopsy cases.  Hum Pathol. 1986;  17 401-410
  • 16 Travis W D, Hoffman G S, Leavitt R Y. et al . Surgical pathology of the lung in Wegener's granulomatosis.  Am J Surg Pathol. 1991;  15 315-333
  • 17 Mark E J, Matsubara O, Tan-Liu N S. et al . The pulmonary biopsy in the early diagnosis of Wegener's (pathergic) granulomatosis.  Hum Pathol. 1988;  19 1065-1071
  • 18 Koldingsnes W, Jacobsen E A, Sildnes T. et al . Pulmonary function and high-resolution CT findings five years after disease onset in patients with WegenerŽs granulomatosis.  Scand J Rheumatol. 2005;  34 220-228
  • 19 Lamprecht P, Reinhold-Keller E, Gross W L, Reuter M. Clinical images: orbital granuloma and subglottic tracheal stenosis in Wegener's granulomatosis.  Arthritis Rheumatism. 2000;  7 1654
  • 20 Gross W L. Primary systemic vasculitis. II: Disease picture.  Internist (Berl). 1999;  40 951-968
  • 21 Guillevin L, Durand-Gasselin B, Cevallos R. et al . Micoscopic polyangiitis. Clinical and laboratory findings in eighty-five patients.  Arthritis Rheum. 1999;  42 421-430
  • 22 Ando Y, Okada F, Matsumoto S, Mori H. Thoracic manifestations of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-related disease: CT findings in 51 patients.  J Comp Assist Tomogr. 2004;  28 710-716
  • 23 Collins C E, Quismorio F P. Pulmonary involvement in microscopic polyangiitis.  Curr Opin Pulm Med. 2005;  11 447-451
  • 24 Schnabel A, Reuter M, Csernok E. et al . Subclinical alveolar bleeding in pulmonary vasculitides. Correlation with indices of disease activity.  Eur Respir J. 1999;  14 118-124
  • 25 Mistry N, Pusey C C, Gaskin G. Markers of pulmonary haemorrhage in microscopic polyangiitis.  Sarcoidosis. 1996;  13 268
  • 26 Homma S, Matsushita H, Nakata K. Pulmonary fibrosis in myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitides.  Respirology. 2004;  9 190-196
  • 27 Eschun G M, Mink S N, Sharma S. Pulmonary interstitial fibrosis as a presenting manifestation in perinuclear antineutrophilic cytoplasmic antibody microscopic polyangiitis.  Chest. 2003;  123 297-301
  • 28 Hellmich B, Ehlers S, Csernok E, Gross W L. Update on the pathogenesis of Churg-Strauss syndrome.  Clin Exp Rheumatol. 2003;  21 69-77
  • 29 Lanham J G, Elkon K B, Pusey C D, Hughes G R. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome.  Medicine. 1984;  63 65-81
  • 30 Choi Y H, Im J G, Han B K. et al . Thoracic manifestation of Churg-Strauss syndrome: radiologic and clinical findings.  Chest. 2000;  117 117-124
  • 31 Worthy S A, Müller N L, Hansell D M, Flower C DR. Churg-Strauss syndrome: the spectrum of pulmonary CT findings in 17 patients.  AJR. 1998;  170 297-300
  • 32 Silva C I, Muller N L, Fujimoto K. et al . Churg-Strauss syndrome: high resolution CT and pathologic findings.  J Thorac Imaging. 2005;  20 74-80
  • 33 Reuter M, Aries P M, Schnabel A, Gross W L. High-resolution computed tomography of the lungs in Churg-Strauss syndrome.  Sarcoidosis. 1997;  14(suppl) 40
  • 34 Buschman D L, Waldron J A, Talmadge E K. Churg-Strauss pulmonary vasculitis: high-resolution computed tomography scanning and pathologic findings.  Am Rev Respir Dis. 1990;  142 458-461
  • 35 Watts R A, Scott D G. Epidemiology of the vasculitides.  Semin Respir Crit Care Med. 2004;  25 455-464
  • 36 Sueyoshi E, Sakamoto I, Ogawa Y, Uetani M. Diagnosis of perfusion abnormality of the pulmonary artery in Takayasu’s arteritis using contrast-enhanced MR perfusion imaging.  Eur Radiol. 2006;  16 1551-1556
  • 37 Nakamura T, Hayashi S, Fukuoka M. et al . Pulmonary infarction as the initial manifestation of Takayasu’s arteritis.  Intern Med. 2006;  45(11) 725-728
  • 38 Morissey N J, Goldman J, Fallon J T. et al . Endovascular aortic biopsy in the diagnosis of takayasu arteritis.  J Endovasc Ther. 2003;  10 136-140
  • 39 Kobayashi Y, Ishii K, Oda K. et al . Aortic wall inflammation due to Takayasu arteriitis imaged with 18F-FDG PET coregistered with enhanced CT.  J Nucl Med. 2005;  46 917-922
  • 40 Marten K, Schnyder P, Schirg E. et al . Pattern-based differential diagnosis in pulmonary vasculitis using volumetric CT.  AJR Am J Roentgenol. 2005;  184 720-733

Prof. Dr. Michael Reuter

Institut für Radiologie und Interventionelle Therapie

Vivantes Klinikum Neukölln

Rudower Str. 48

12351 Berlin

Phone: 030/6004-2070

Fax: 030/6004-3271

Email: michael.reuter@vivantes.de

    >