1. Wegner’s
Granulomatosis
Dr/ Hytham Nafady
Hertz

2. Definition
Multisystem disease of unknown etiology
characterized by
• Granulomatous necrotizing small vessel
vasculitis of the upper & lower respiratory
tract &
• Glomerulonephritis.

4. Wegner’s granulomatosis involves the
• upper respiratory tract in 100% of cases,
• lower respiratory tract in 90% of cases &
• kidneys in 80% of cases, &
• Tracheo-bronchial tree in 60% of cases.

5. Demographics
• Age: around 45.
• M>F

6. C.P
• Rhinitis, sinusitis & epistaxis.
• Cough & hemoptysis.
• Hematuria & Chronic renal failure,
which is the cause of death.
• Lab: elevated (c-ANAC) antineutrophil
antibodies.
• Renal biopsy: glomerulonephritis,
which is diagnostic.

7. Radiological manifestations

8. Respiratory manifestations
of
Wegner’s granulomatosis
Nodules
Alveolar
opacities
Airways
Ground
glass
opacities
Consolidation
Subglottic
tracheal
stenosis
Bronchial
stenosis
Cavitating
Non cavitating

9. Rare manifestations of WG
• Interstitial abnormalities (thickening of
interlobular sepat).
• Hilar lymphadenopathy.
• Pleural thickening or effusion.

10. Nodules
• Single or multiple.
• Small or large (few mm to 10 cm).
• Cavitating or non cavitating.
• Thin walled (1-3 mm) or thick walled (> 3
mm) cavities.
• Halo sign (due to surrounding alveolar
hemorrhage).
• Reversed halo sign.

15. Halo sign

16. Reversed halo sign

17. Alveolar WG
Due to alveolar hemorrhage.
Alveolar WG
Ground glass opacities Consolidation
Centrilobular nodules Patchy distribution

18. Centrilobular nodules of GG density

19. GGO with patchy distribution

20. Consolidation

21. Airway WG
• Subglottic tracheal stenosis.
• Bronchial stenosis

22. Case
27-year-old woman involved in a severe motor
vehicle collision years ago with a prolonged
hospital course now presents with a several
months history of progressive dyspnea.
• What is the pertinent radiologic finding?
• What is your differential diagnosis?
• What is your favorite diagnosis?

25. DD of tracheal stenosis