Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0042-1742578
Computed Tomography of Chest in Non-Infectious Granulomatous Lung Diseases: A Pictorial Essay
![](https://www.thieme-connect.de/media/10.1055-s-00058257/202201/lookinside/thumbnails/10-1055-s-0042-1742578_0008-1.jpg)
Abstract
Non-infectious granulomatous lung diseases represent a group of disorders with relatively non-specific clinical history and imaging findings. Following pathologies are enlisted, (1) Inflammatory: sarcoidosis and necrotizing sarcoid granulomatosis (NSG); (2) Pulmonary lymphoid lesions: lymphomatoid granulomatosis (LYG) and granulomatous-lymphocytic interstitial lung disease (GLILD); (3) Aspiration/exposure: aspiration pneumonia, talcosis, berylliosis, and hypersensitivity pneumonitis (HP); (4) Vasculitis: granulomatosis with polyangiitis and eosinophilic GPA (EGPA) (formerly called as Churg-Strauss syndrome); and (5) Collagen vascular disorders: rheumatoid lung nodules. Role of radiologist is to narrow the diagnosis combining the imaging findings with clinical findings thus following a multidisciplinary approach.
Publication History
Article published online:
19 September 2023
© 2022. Indographics. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Sergew A, Fernández Pérez ER. Current approach to diagnosis and management of pulmonary eosinophilic syndromes: eosinophilic pneumonias, eosinophilic granulomatosis with polyangiitis, and hypereosinophilic syndrome. Semin Respir Crit Care Med 2016; 37 (03) 441-456
- 2 Low SE, Nicol A. Talc induced pulmonary granulomatosis. J Clin Pathol 2006; 59 (02) 223
- 3 Lohrmann C, Uhl M, Kotter E, Burger D, Ghanem N, Langer M. Pulmonary manifestations of Wegener granulomatosis: CT findings in 57 patients and a review of the literature. Eur J Radiol 2005; 53 (03) 471-477
- 4 Shinichiro Ohshimo, Josune Guzman, Ulrich Costabel, Francesco Bonella European Respiratory Review 2017 26: 170012; DOI: 10.1183/16000617.0012-2017
- 5 Neville E, Walker AN, James DG. Prognostic factors predicting the outcome of sarcoidosis: an analysis of 818 patients. Q J Med 1983; 52 (208) 525-533
- 6 Brauner MW, Lenoir S, Grenier P, Cluzel P, Battesti JP, Valeyre D. Pulmonary sarcoidosis: CT assessment of lesion reversibility. Radiology 1992; 182 (02) 349-354
- 7 Baughman RP, Winget DB, Bowen EH, Lower EE. Predicting respiratory failure in sarcoidosis patients. Sarcoidosis Vasc Diffuse Lung Dis 1997; 14 (02) 154-158
- 8 Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med 1997; 336 (17) 1224-1234
- 9 Rosen Y. Sarcoidosis. In: Dail DH, Hammer SP. eds. Pulmonary Pathology. New York, NY: Springer-Verlag; 1994: 13-645
- 10 Churg A, Carrington CB, Gupta R. Necrotizing sarcoid granulomatosis. Chest 1979; 76 (04) 406-413
- 11 Criado E, Sánchez M, Ramírez J. et al. Pulmonary sarcoidosis: typical and atypical manifestations at high resolution computed tomography with pathologic correlation. Radiographics 2010; 30 (06) 1567-1586
- 12 Müller NL, Kullnig P, Miller RR. The CT findings of pulmonary sarcoidosis: analysis of 25 patients. AJR Am J Roentgenol 1989; 152 (06) 1179-1182
- 13 Koyama T, Ueda H, Togashi K, Umeoka S, Kataoka M, Nagai S. Radiologic manifestations of sarcoidosis in various organs. Radiographics 2004; 24 (01) 87-104
- 14 Hamper UM, Fishman EK, Khouri NF, Johns CJ, Wang KP, Siegelman SS. Typical and atypical CT manifestations of pulmonary sarcoidosis. J Comput Assist Tomogr 1986; 10 (06) 928-936
- 15 Collins J, Stern EJ. Chest Radiology, the Essentials. Lippincott Williams & Wilkins; 2007
- 16 Naidich DP, Srichai MB, Krinsky GA. Computed Tomography and Magnetic Resonance of the Thorax. Lippincott Williams & Wilkins; 2007
- 17 Ganeshan D, Menias CO, Lubner MG, Pickhardt PJ, Sandrasegaran K, Bhalla S. Sarcoidosis from head to toe: what the radiologist needs to know. Radiographics 2018; 38 (04) 1180-1200
- 18 Conant EF, Glickstein MF, Mahar P, Miller WT. Pulmonary sarcoidosis in the older patient: conventional radiographic features. Radiology 1988; 169 (02) 315-319
- 19 Freundlich IM, Libshitz HI, Glassman LM, Israel HL. Sarcoidosis. Typical and atypical thoracic manifestations and complications. Clin Radiol 1970; 21 (04) 376-383
- 20 Liebow AA. The J. Burns Amberson Lecture Pulmonary Angiitis and Granulomatosis. Am Rev Respir Dis 1973; 108: 1-18
- 21 Lazzarini LCO, de Fatima do Amparo Teixeira M, Souza Rodrigues R, Marcos Nunes Valiante P. Necrotizing sarcoid granulomatosis in a family of patients with sarcoidosis reinforces the association between both entities. Respiration 2008; 76 (03) 356-360
- 22 Chittock DR, Joseph MG, Paterson NA, McFadden RG. Necrotizing sarcoid granulomatosis with pleural involvement. Clinical and radiographic features. Chest 1994; 106 (03) 672-676
- 23 Komiya K, Ishii H, Umeki K. et al. Computed tomography findings of aspiration pneumonia in 53 patients. Geriatr Gerontol Int 2013; 13 (03) 580-585
- 24 Hirschmann JV, Pipavath SNJ, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics 2009; 29 (07) 1921-1938
- 25 Miller R, Allen TC, Barrios RJ. et al. Hypersensitivity pneumonitis: a perspective from members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2018; 142 (01) 120-126
- 26 Matar LD, McAdams HP, Sporn TA. Hypersensitivity pneumonitis. AJR Am J Roentgenol 2000; 174 (04) 1061-1066
- 27 Yi ES. Hypersensitivity pneumonitis. Crit Rev Clin Lab Sci 2002; 39 (06) 581-629
- 28 Allen DH, Basten A, Williams GV, Woolcock AJ. Familial hypersensitivity pneumonitis. Am J Med 1975; 59 (04) 505-514
- 29 Ohtsuka Y, Munakata M, Tanimura K. et al. Smoking promotes insidious and chronic farmer's lung disease, and deteriorates the clinical outcome. Intern Med 1995; 34 (10) 966-971
- 30 Raghu G, Remy-Jardin M, Ryerson CJ. et al. Diagnosis of hypersensitivity pneumonitis in adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202 (03) e36-e69
- 31 Remy-Jardin M, Remy J, Wallaert B, Müller NL. Subacute and chronic bird breeder hypersensitivity pneumonitis: sequential evaluation with CT and correlation with lung function tests and bronchoalveolar lavage. Radiology 1993; 189 (01) 111-118
- 32 Cormier Y, Brown M, Worthy S, Racine G, Müller NL. High-resolution computed tomographic characteristics in acute farmer's lung and in its follow-up. Eur Respir J 2000; 16 (01) 56-60
- 33 Franquet T, Hansell DM, Senbanjo T, Remy-Jardin M, Müller NL. Lung cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr 2003; 27 (04) 475-478
- 34 Feigin DS. Talc: understanding its manifestations in the chest. AJR Am J Roentgenol 1986; 146 (02) 295-301
- 35 Paré JP, Cote G, Fraser RS. Long-term follow-up of drug abusers with intravenous talcosis. Am Rev Respir Dis 1989; 139 (01) 233-241
- 36 Stern EJ, Frank MS, Schmutz JF, Glenny RW, Schmidt RA, Godwin JD. Panlobular pulmonary emphysema caused by i.v. injection of methylphenidate (Ritalin): findings on chest radiographs and CT scans. AJR Am J Roentgenol 1994; 162 (03) 555-560
- 37 Ward S, Heyneman LE, Reittner P, Kazerooni EA, Godwin JD, Müller NL. Talcosis associated with IV abuse of oral medications: CT findings. AJR Am J Roentgenol 2000; 174 (03) 789-793
- 38 Akira M, Kozuka T, Yamamoto S, Sakatani M, Morinaga K. Inhalational talc pneumoconiosis: radiographic and CT findings in 14 patients. AJR Am J Roentgenol 2007; 188 (02) 326-333
- 39 Marchiori E, Souza Júnior AS, Müller NL. Inhalational pulmonary talcosis: high-resolution CT findings in 3 patients. J Thorac Imaging 2004; 19 (01) 41-44
- 40 Woywodt A, Matteson EL. Wegener's granulomatosis–probing the untold past of the man behind the eponym. Rheumatology (Oxford) 2006; 45 (10) 1303-1306
- 41 Allen SD, Harvey CJ. Imaging of Wegener's granulomatosis. Br J Radiol 2007; 80 (957) 757-765
- 42 Pretorius ES, Stone JH, Hellman DB, Fishman EK. Wegener's granulomatosis: CT evolution of pulmonary parenchymal findings in treated disease. Crit Rev Computed Tomogr 2004; 45 (01) 67-85
- 43 Naeem M, Ballard DH, Jawad H, Raptis C, Bhalla S. Noninfectious granulomatous diseases of the chest. Radiographics 2020; 40 (04) 1003-1019
- 44 Savage CO, Harper L, Cockwell P, Adu D, Howie AJ. ABC of arterial and vascular disease: vasculitis. BMJ 2000; 320 (7245): 1325-1328
- 45 Watts RA, Robson J. Introduction, epidemiology and classification of vasculitis. Best Pract Res Clin Rheumatol 2018; 32 (01) 3-20
- 46 Li J, Li C, Li J. Thoracic manifestation of Wegener's granulomatosis: computed tomography findings and analysis of misdiagnosis. Exp Ther Med 2018; 16 (01) 413-419
- 47 Maskell GF, Lockwood CM, Flower CD. Computed tomography of the lung in Wegener's granulomatosis. Clin Radiol 1993; 48 (06) 377-380
- 48 Ananthakrishnan L, Sharma N, Kanne JP. Wegener's granulomatosis in the chest: high-resolution CT findings. AJR Am J Roentgenol 2009; 192 (03) 676-682
- 49 Lee KS, Kim TS, Fujimoto K. et al. Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients. Eur Radiol 2003; 13 (01) 43-51
- 50 Agarwal R, Aggarwal AN, Gupta D. Another cause of reverse halo sign: Wegener's granulomatosis. Br J Radiol 2007; 80 (958) 849-850
- 51 Kuhlman JE, Hruban RH, Fishman EK. Wegener granulomatosis: CT features of parenchymal lung disease. J Comput Assist Tomogr 1991; 15 (06) 948-952
- 52 Farrelly CA. Wegener's granulomatosis: a radiological review of the pulmonary manifestations at initial presentation and during relapse. Clin Radiol 1982; 33 (05) 545-551
- 53 Lenclud C, De Vuyst P, Dupont E, Depierreux M, Ketelbant P, Goldman M. Wegener's granulomatosis presenting as acute respiratory failure with anti-neutrophil-cytoplasm antibodies. Chest 1989; 96 (02) 345-347
- 54 Stokes TC, McCann BG, Rees RT, Sims EH, Harrison BD. Acute fulminating intrapulmonary haemorrhage in Wegener's granulomatosis. Thorax 1982; 37 (04) 315-316
- 55 Franks TJ, Koss MN. Pulmonary capillaritis. Curr Opin Pulm Med 2000; 6 (05) 430-435
- 56 Polychronopoulos VS, Prakash UB, Golbin JM, Edell ES, Specks U. Airway involvement in Wegener's granulomatosis. Rheum Dis Clin North Am 2007; 33 (04) 755-775 , vi vi
- 57 Langford CA, Sneller MC, Hallahan CW. et al. Clinical features and therapeutic management of subglottic stenosis in patients with Wegener's granulomatosis. Arthritis Rheum 1996; 39 (10) 1754-1760
- 58 Prince JS, Duhamel DR, Levin DL, Harrell JH, Friedman PJ. Nonneoplastic lesions of the tracheobronchial wall: radiologic findings with bronchoscopic correlation. Radiographics 2002; 22 (Spec No): S215-S230
- 59 McDonald TJ, Neel III HB, DeRemee RA. Wegener's granulomatosis of the subglottis and the upper portion of the trachea. Ann Otol Rhinol Laryngol 1982; 91 (6 Pt 1): 588-592
- 60 Summers RM, Aggarwal NR, Sneller MC. et al. CT virtual bronchoscopy of the central airways in patients with Wegener's granulomatosis. Chest 2002; 121 (01) 242-250
- 61 Price M, Gilman MD, Carter BW, Sabloff BS, Truong MT, Wu CC. Imaging of eosinophilic lung diseases. Radiol Clin North Am 2016; 54 (06) 1151-1164
- 62 Chung MP, Yi CA, Lee HY, Han J, Lee KS. Imaging of pulmonary vasculitis. Radiology 2010; 255 (02) 322-341
- 63 Kim YK, Lee KS, Chung MP. et al. Pulmonary involvement in Churg-Strauss syndrome: an analysis of CT, clinical, and pathologic findings. Eur Radiol 2007; 17 (12) 3157-3165
- 64 Masi AT, Hunder GG, Lie JT. et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum 1990; 33 (08) 1094-1100
- 65 Groh M, Pagnoux C, Baldini C. et al. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management. Eur J Intern Med 2015; 26 (07) 545-553
- 66 Jeong YJ, Kim KI, Seo IJ. et al. Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Radiographics 2007; 27 (03) 617-637 , discussion 637–639
- 67 Jolles H, Moseley PL, Peterson MW. Nodular pulmonary opacities in patients with rheumatoid arthritis. A diagnostic dilemma. Chest 1989; 96 (05) 1022-1025
- 68 Hurd ER. Extraarticular manifestations of rheumatoid arthritis. Semin Arthritis Rheum 1979; 8 (03) 151-176
- 69 Brown KK. Rheumatoid lung disease. Proc Am Thorac Soc 2007; 4 (05) 443-448
- 70 Franquet T. High-resolution CT of lung disease related to collagen vascular disease. Radiol Clin North Am 2001; 39 (06) 1171-1187
- 71 Chaudhry AA, Gul M, Chaudhry AA, Moore W. Case 238: spontaneous pneumothorax secondary to intrapulmonary necrobiotic rheumatoid nodule. Radiology 2017; 282 (02) 602-608
- 72 Tanoue LT. Pulmonary manifestations of rheumatoid arthritis. Clin Chest Med 1998; 19 (04) 667-685 , viii
- 73 Roschewski M, Wilson WH. Lymphomatoid granulomatosis. Cancer J 2012; 18 (05) 469-474
- 74 Yamanouchi T, Kawanami S, Kamitani T. et al. Lymphomatoid granulomatosis: two different phenotypes of computed tomography findings. J Thorac Imaging 2016; 31 (06) W80-W82
- 75 King TE. Pulmonary lymphomatoid granulomatosis. In: Post TW. ed. UpToDate. Waltham, MA: UpToDate; 2017
- 76 Abbott GF, Rosado-de-Christenson ML, Franks TJ, Frazier AA, Galvin JR. Pulmonary Langerhans cell histiocytosis. 2004; 24 (03) 821-841
- 77 Vassallo R, Ryu JH, Colby TV, Hartman T, Limper AH. Pulmonary Langerhans'-cell histiocytosis. N Engl J Med 2000; 342 (26) 1969-1978
- 78 Sundar KM, Gosselin MV, Chung HL, Cahill BC. Pulmonary Langerhans cell histiocytosis: emerging concepts in pathobiology, radiology, and clinical evolution of disease. Chest 2003; 123 (05) 1673-1683
- 79 Bierry G, Boileau J, Barnig C. et al. Thoracic manifestations of primary humoral immunodeficiency: a comprehensive review. Radiographics 2009; 29 (07) 1909-1920
- 80 Park JH, Levinson AI. Granulomatous-lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency (CVID). Clin Immunol 2010; 134 (02) 97-103