Imaging of Pulmonary Vasculitis

Published Online:Apr 8 2010https://doi.org/10.1148/radiol.10090105

Abstract

It is essential to integrate clinical, laboratory, and imaging findings to make a specific diagnosis of pulmonary vasculitides

The presence of pulmonary vasculitis can be suggested by a clinical presentation that includes diffuse pulmonary hemorrhage, acute glomerulonephritis, chronic refractory sinusitis or rhinorrhea, imaging findings of nodules or cavities, mononeuritis multiplex, multisystemic disease, and palpable purpura. Serologic tests, including the use of cytoplasmic antineutrophil cytoplasmic antibody (ANCA) and perinuclear ANCA, are performed for the differential diagnosis of the diseases. A positive cytoplasmic ANCA test result is specific enough to make a diagnosis of ANCA-associated granulomatous vasculitis if the clinical features are typical. Perinuclear ANCA positivity raises the possibility of Churg-Strauss syndrome or microscopic polyangiitis. Imaging findings of pulmonary vasculitis are diverse and often poorly specific. The use of a pattern-based approach to the imaging findings may help narrow the differential diagnosis of various pulmonary vasculitides. Integration of clinical, laboratory, and imaging findings is mandatory for making a reasonably specific diagnosis.

References

1 Brown KK . Pulmonary vasculitis. Proc Am Thorac Soc 2006;3(1):48–57. Crossref, Medline, Google Scholar
2 Hansell DM . Small-vessel diseases of the lung: CT-pathologic correlates. Radiology 2002;225(3):639–653. Link, Google Scholar
3 Frankel SK , Cosgrove GP , Fischer A , Meehan RT , Brown KK . Update in the diagnosis and management of pulmonary vasculitis. Chest 2006;129(2):452–465. Crossref, Medline, Google Scholar
4 Hagen EC , Daha MR , Hermans J , et al. . Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis. EC/BCR Project for ANCA Assay Standardization. Kidney Int 1998;53(3):743–753. Crossref, Medline, Google Scholar
5 Guillevin L , Durand-Gasselin B , Cevallos R , et al. . Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients. Arthritis Rheum 1999;42(3):421–430. Crossref, Medline, Google Scholar
6 Mulder AH , Horst G , van Leeuwen MA , Limburg PC , Kallenberg CG . Antineutrophil cytoplasmic antibodies in rheumatoid arthritis: characterization and clinical correlations. Arthritis Rheum 1993;36(8):1054–1060. Crossref, Medline, Google Scholar
7 Schnabel A , Csernok E , Isenberg DA , Mrowka C , Gross WL . Antineutrophil cytoplasmic antibodies in systemic lupus erythematosus: prevalence, specificities, and clinical significance. Arthritis Rheum 1995;38(5):633–637. Crossref, Medline, Google Scholar
8 Kerr GS , Fleisher TA , Hallahan CW , Leavitt RY , Fauci AS , Hoffman GS . Limited prognostic value of changes in antineutrophil cytoplasmic antibody titers in patients with Wegener’s granulomatosis. Adv Exp Med Biol 1993;336:411–414. Crossref, Medline, Google Scholar
9 Ara J , Mirapeix E , Rodriguez R , Saurina A , Darnell A . Relationship between ANCA and disease activity in small vessel vasculitis patients with anti-MPO ANCA. Nephrol Dial Transplant 1999;14(7):1667–1672. Crossref, Medline, Google Scholar
10 Lee KS , Kim TS , Han J , et al. . Diffuse micronodular lung disease: HRCT and pathologic findings. J Comput Assist Tomogr 1999;23(1):99–106. Crossref, Medline, Google Scholar
11 Seo JB , Im J-G , Chung JW , et al. . Pulmonary vasculitis: the spectrum of radiological findings. Br J Radiol 2000;73(875):1224–1231. Crossref, Medline, Google Scholar
12 Ravenel JG , McAdams HP . Pulmonary vasculitis: CT features. Semin Respir Crit Care Med 2003;24(4):427–436. Crossref, Medline, Google Scholar
13 Peachell MB , Muller NL . Pulmonary vasculitis. Semin Respir Crit Care Med 2004;25(5):483–489. Crossref, Medline, Google Scholar
14 Marten K , Schnyder P , Schirg E , Prokop M , Rummeny EJ , Engelke C . Pattern-based differential diagnosis in pulmonary vasculitis using volumetric CT. AJR Am J Roentgenol 2005;184(3):720–733. Crossref, Medline, Google Scholar
15 Jennette JC , Falk RJ , Andrassy K , et al. . Nomenclature of systemic vasculitides: proposal of an international consensus conference. Arthritis Rheum 1994;37(2):187–192. Crossref, Medline, Google Scholar
16 Jennings CA , King TE , Tuder R , Cherniack RM , Schwarz MI . Diffuse alveolar hemorrhage with underlying isolated, pauciimmune pulmonary capillaritis. Am J Respir Crit Care Med 1997;155(3):1101–1109. Crossref, Medline, Google Scholar
17 Jennette JC , Falk RJ . New insight into the pathogenesis of vasculitis associated with antineutrophil cytoplasmic autoantibodies. Curr Opin Rheumatol 2008;20(1):55–60. Crossref, Medline, Google Scholar
18 Eschun GM , Mink SN , Sharma S . Pulmonary interstitial fibrosis as a presenting manifestation in perinuclear antineutrophilic cytoplasmic antibody microscopic polyangiitis. Chest 2003;123(1):297–301. Crossref, Medline, Google Scholar
19 Nathani N , Little MA , Kunst H , Wilson D , Thickett DR . Churg-Strauss syndrome and leukotriene antagonist use: a respiratory perspective. Thorax 2008;63(10):883–888. Crossref, Medline, Google Scholar
20 Cojocaru M , Cojocaru IM , Iacob SA . Prevalence of anti-neutrophil cytoplasmic antibodies in patients with chronic hepatitis C infection associated mixed cryoglobulinemia. Rom J Intern Med 2006;44(4):427–431. Medline, Google Scholar
21 Zholudev A , Zurakowski D , Young W , Leichtner A , Bousvaros A . Serologic testing with ANCA, ASCA, and anti-OmpC in children and young adults with Crohn’s disease and ulcerative colitis: diagnostic value and correlation with disease phenotype. Am J Gastroenterol 2004;99(11):2235–2241. Crossref, Medline, Google Scholar
22 Seko Y . Giant cell and Takayasu arteritis. Curr Opin Rheumatol 2007;19(1):39–43. Crossref, Medline, Google Scholar
23 Kobayashi Y , Numano F . 3. Takayasu arteritis. Intern Med 2002;41(1):44–46. Crossref, Medline, Google Scholar
24 Johnston SL , Lock RJ , Gompels MM . Takayasu arteritis: a review. J Clin Pathol 2002;55(7):481–486. Crossref, Medline, Google Scholar
25 Matsubara O , Yoshimura N , Tamura A , et al. . Pathological features of the pulmonary artery in Takayasu arteritis. Heart Vessels Suppl 1992;7 18–25. Crossref, Medline, Google Scholar
26 Yamato M , Lecky JW , Hiramatsu K , Kohda E . Takayasu arteritis: radiographic and angiographic findings in 59 patients. Radiology 1986;161(2):329–334. Link, Google Scholar
27 Rizzi R , Bruno S , Stellacci C , Dammacco R . Takayasu’s arteritis: a cell-mediated large-vessel vasculitis. Int J Clin Lab Res 1999;29(1):8–13. Crossref, Medline, Google Scholar
28 Park JH , Chung JW , Im J-G , Kim SK , Park YB , Han MC . Takayasu arteritis: evaluation of mural changes in the aorta and pulmonary artery with CT angiography. Radiology 1995;196(1):89–93. Link, Google Scholar
29 Desai MY , Stone JH , Foo TK , Hellmann DB , Lima JA , Bluemke DA . Delayed contrast-enhanced MRI of the aortic wall in Takayasu’s arteritis: initial experience. AJR Am J Roentgenol 2005;184(5):1427–1431. Crossref, Medline, Google Scholar
30 Choe YH , Han BK , Koh EM , Kim DK , Do YS , Lee WR . Takayasu’s arteritis: assessment of disease activity with contrast-enhanced MR imaging. AJR Am J Roentgenol 2000;175(2):505–511. Crossref, Medline, Google Scholar
31 Schmidt WA , Blockmans D . Use of ultrasonography and positron emission tomography in the diagnosis and assessment of large-vessel vasculitis. Curr Opin Rheumatol 2005;17(1):9–15. Crossref, Medline, Google Scholar
32 Matsunaga N , Hayashi K , Sakamoto I , Ogawa Y , Matsumoto T . Takayasu arteritis: protean radiologic manifestations and diagnosis. RadioGraphics 1997;17(3):579–594. Link, Google Scholar
33 Canyigit M , Peynircioglu B , Hazirolan T , et al. . Imaging characteristics of Takayasu arteritis. Cardiovasc Intervent Radiol 2007;30(4):711–718. Crossref, Medline, Google Scholar
34 Woywodt A , Matteson EL . Wegener’s granulomatosis: probing the untold past of the man behind the eponym. Rheumatology (Oxford) 2006;45(10):1303–1306. Crossref, Medline, Google Scholar
35 Lamprecht P , Gross WL . Wegener’s granulomatosis. Herz 2004;29(1):47–56. Crossref, Medline, Google Scholar
36 Bosch X , Guilabert A , Espinosa G , Mirapeix E . Treatment of antineutrophil cytoplasmic antibody associated vasculitis: a systematic review. JAMA 2007;298(6):655–669. Crossref, Medline, Google Scholar
37 Travis WD , Hoffman GS , Leavitt RY , Pass HI , Fauci AS . Surgical pathology of the lung in Wegener’s granulomatosis: review of 87 open lung biopsies from 67 patients. Am J Surg Pathol 1991;15(4):315–333. Crossref, Medline, Google Scholar
38 Yousem SA . Bronchocentric injury in Wegener’s granulomatosis: a report of five cases. Hum Pathol 1991;22(6):535–540. Crossref, Medline, Google Scholar
39 Yousem SA , Lombard CM . The eosinophilic variant of Wegener’s granulomatosis. Hum Pathol 1988;19(6):682–688. Crossref, Medline, Google Scholar
40 Uner AH , Rozum-Slota B , Katzenstein AL . Bronchiolitis obliterans-organizing pneumonia (BOOP)-like variant of Wegener’s granulomatosis: a clinicopathologic study of 16 cases. Am J Surg Pathol 1996;20(7):794–801. Crossref, Medline, Google Scholar
41 Travis WD , Colby TV , Lombard C , Carpenter HA . A clinicopathologic study of 34 cases of diffuse pulmonary hemorrhage with lung biopsy confirmation. Am J Surg Pathol 1990;14(12):1112–1125. Crossref, Medline, Google Scholar
42 Leavitt RY , Fauci AS , Bloch DA , et al. . The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 1990;33(8):1101–1107. Crossref, Medline, Google Scholar
43 Aberle DR , Gamsu G , Lynch D . Thoracic manifestations of Wegener granulomatosis: diagnosis and course. Radiology 1990;174(3 pt 1):703–709. Link, Google Scholar
44 Kim SJ , Lee KS , Ryu YH , et al. . Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol 2003;180(5):1251–1254. Crossref, Medline, Google Scholar
45 Cordier JF , Valeyre D , Guillevin L , Loire R , Brechot JM . Pulmonary Wegener’s granulomatosis: a clinical and imaging study of 77 cases. Chest 1990;97(4):906–912. Crossref, Medline, Google Scholar
46 Reuter M , Schnabel A , Wesner F , et al. . Pulmonary Wegener’s granulomatosis: correlation between high-resolution CT findings and clinical scoring of disease activity. Chest 1998;114(2):500–506. Crossref, Medline, Google Scholar
47 Lee KS , Kim TS , Fujimoto K , et al. . Thoracic manifestation of Wegener’s granulomatosis: CT findings in 30 patients. Eur Radiol 2003;13(1):43–51. Crossref, Medline, Google Scholar
48 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(3):471–477. Crossref, Medline, Google Scholar
49 Attali P , Begum R , Ban Romdhane H , Valeyre D , Guillevin L , Brauner MW . Pulmonary Wegener’s granulomatosis: changes at follow-up CT. Eur Radiol 1998;8(6):1009–1113. Crossref, Medline, Google Scholar
50 Pretorius ES , Stone JH , Hellmann DB , Fishman EK . Wegener’s granulomatosis: spectrum of CT findings in diagnosis, disease progression, and response to therapy. Crit Rev Diagn Imaging 2000;41(4):279–313. Crossref, Medline, Google Scholar
51 Pretorius ES , Stone JH , Hellman DB , Fishman EK . Wegener’s Granulomatosis: CT evolution of pulmonary parenchymal findings in treated disease. Crit Rev Comput Tomogr 2004;45(1):67–85. Crossref, Medline, Google Scholar
52 Keogh KA , Specks U . Churg-Strauss syndrome: clinical presentation, antineutrophil cytoplasmic antibodies, and leukotriene receptor antagonists. Am J Med 2003;115(4):284–290. Crossref, Medline, Google Scholar
53 Val-Bernal JF , Mayorga M , García-Alberdi E , Pozueta JA . Churg-Strauss syndrome and sudden cardiac death. Cardiovasc Pathol 2003;12(2):94–97. Crossref, Medline, Google Scholar
54 Keogh KA , Specks U . Churg-Strauss syndrome. Semin Respir Crit Care Med 2006;27(2):148–157. Crossref, Medline, Google Scholar
55 Katzenstein AL . Diagnostic features and differential diagnosis of Churg-Strauss syndrome in the lung: a review. Am J Clin Pathol 2000;114(5):767–772. Crossref, Medline, Google Scholar
56 Lanham JG , Elkon KB , Pusey CD , Hughes GR . Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine (Baltimore) 1984;63(2):65–81. Crossref, Medline, Google Scholar
57 Guillevin L , Cohen P , Gayraud M , Lhote F , Jarrousse B , Casassus P . Churg-Strauss syndrome: clinical study and long-term follow-up of 96 patients. Medicine (Baltimore) 1999;78(1):26–37. Crossref, Medline, Google Scholar
58 Kim Y , Lee KS , Choi DC , Primack SL , Im JG . The spectrum of eosinophilic lung disease: radiologic findings. J Comput Assist Tomogr 1997;21(6):920–930. Crossref, Medline, Google Scholar
59 Worthy SA , Müller NL , Hansell DM , Flower CD . Churg-Strauss syndrome: the spectrum of pulmonary CT findings in 17 patients. AJR Am J Roentgenol 1998;170(2):297–300. Crossref, Medline, Google Scholar
60 Silva CI , Müller NL , Fujimoto K , Johkoh T , Ajzen SA , Churg A . Churg-Strauss syndrome: high resolution CT and pathologic findings. J Thorac Imaging 2005;20(2):74–80. Crossref, Medline, Google Scholar
61 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. Crossref, Medline, Google Scholar
62 Choi YH , Im J-G , Han BK , Kim JH , Lee KY , Myoung NH . Thoracic manifestation of Churg-Strauss syndrome: radiologic and clinical findings. Chest 2000;117(1):117–124. Crossref, Medline, Google Scholar
63 Johkoh T , Müller NL , Akira M , et al. . Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients. Radiology 2000;216(3):773–780. Link, Google Scholar
64 Okada F , Ando Y , Yoshitake S , et al. . Clinical/pathologic correlations in 553 patients with primary centrilobular findings on high-resolution CT scan of the thorax. Chest 2007;132(6):1939–1948. Crossref, Medline, Google Scholar
65 Jennette JC , Thomas DB , Falk RJ . Microscopic polyangiitis (microscopic polyarteritis). Semin Diagn Pathol 2001;18(1):3–13. Medline, Google Scholar
66 Jennette JC , Falk RJ . Small-vessel vasculitis. N Engl J Med 1997;337(21):1512–1523. Crossref, Medline, Google Scholar
67 Niles JL , Böttinger EP , Saurina GR , et al. . The syndrome of lung hemorrhage and nephritis is usually an ANCA-associated condition. Arch Intern Med 1996;156(4):440–445. Crossref, Medline, Google Scholar
68 Pagnoux C , Guilpain P , Guillevin L . Microscopic polyangiitis. [in French]. Presse Med 2007;36(5 pt 2):895–901. Crossref, Medline, Google Scholar
69 Collins CE , Quismorio FP . Pulmonary involvement in microscopic polyangiitis. Curr Opin Pulm Med 2005;11(5):447–451. Crossref, Medline, Google Scholar
70 Lauque D , Cadranel J , Lazor R , et al. . Microscopic polyangiitis with alveolar hemorrhage: a study of 29 cases and review of the literature. Groupe d’Etudes et de Recherche sur les Maladies “Orphelines” Pulmonaires (GERM”O”P). Medicine (Baltimore) 2000;79(4):222–233. Crossref, Medline, Google Scholar
71 Primack SL , Miller RR , Müller NL . Diffuse pulmonary hemorrhage: clinical, pathologic, and imaging features. AJR Am J Roentgenol 1995;164(2):295–300. Crossref, Medline, Google Scholar
72 Primack SL , Hartman TE , Lee KS , Müller NL . Pulmonary nodules and the CT halo sign. Radiology 1994;190(2):513–515. Link, Google Scholar
73 Cheah FK , Sheppard MN , Hansell DM . Computed tomography of diffuse pulmonary haemorrhage with pathological correlation. Clin Radiol 1993;48(2):89–93. Crossref, Medline, Google Scholar
74 Gülbay BE , Celik G , Kumbasar O , Gülbay M , Alper D , Tulunay O . Microscopic polyangiitis with unusual lung involvement. Respirology 2005;10(5):678–681. Crossref, Medline, Google Scholar
75 Rubin GD , Edwards DK , , Reicher MA , Doemeny JM , Carson SH . Diagnosis of pulmonary hemosiderosis by MR imaging. AJR Am J Roentgenol 1989;152(3):573–574. Crossref, Medline, Google Scholar
76 Saulsbury FT . Henoch-Schönlein purpura. Curr Opin Rheumatol 2001;13(1):35–40. Crossref, Medline, Google Scholar
77 Gardner-Medwin JM , Dolezalova P , Cummins C , Southwood TR . Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002;360(9341):1197–1202. Crossref, Medline, Google Scholar
78 Nadrous HF , Yu AC , Specks U , Ryu JH . Pulmonary involvement in Henoch-Schönlein purpura. Mayo Clin Proc 2004;79(9):1151–1157. Medline, Google Scholar
79 Sansonno D , Dammacco F . Hepatitis C virus, cryoglobulinaemia, and vasculitis: immune complex relations. Lancet Infect Dis 2005;5(4):227–236. Crossref, Medline, Google Scholar
80 Ramos-Casals M , Robles A , Brito-Zerón P , et al. . Life-threatening cryoglobulinemia: clinical and immunological characterization of 29 cases. Semin Arthritis Rheum 2006;36(3):189–196. Crossref, Medline, Google Scholar
81 Blanco R , Martínez-Taboada VM , Rodríguez-Valverde V , García-Fuentes M . Cutaneous vasculitis in children and adults: associated diseases and etiologic factors in 303 patients. Medicine (Baltimore) 1998;77(6):403–418. Crossref, Medline, Google Scholar
82 Koutkia P , Mylonakis E , Rounds S , Erickson A . Leucocytoclastic vasculitis: an update for the clinician. Scand J Rheumatol 2001;30(6):315–322. Crossref, Medline, Google Scholar
83 Uzun O , Akpolat T , Erkan L . Pulmonary vasculitis in behcet disease: a cumulative analysis. Chest 2005;127(6):2243–2253. Crossref, Medline, Google Scholar
84 Erkan F , Gül A , Tasali E . Pulmonary manifestations of Behçet’s disease. Thorax 2001;56(7):572–578. Crossref, Medline, Google Scholar
85 Hamuryudan V , Yurdakul S , Moral F , et al. . Pulmonary arterial aneurysms in Behçet’s syndrome: a report of 24 cases. Br J Rheumatol 1994;33(1):48–51. Crossref, Medline, Google Scholar
86 Numan F , Islak C , Berkmen T , Tüzün H , Cokyüksel O . Behçet disease: pulmonary arterial involvement in 15 cases. Radiology 1994;192(2):465–468. Link, Google Scholar
87 Tunaci M , Ozkorkmaz B , Tunaci A , Gül A , Engin G , Acunaş B . CT findings of pulmonary artery aneurysms during treatment for Behcet’s disease. AJR Am J Roentgenol 1999;172(3):729–733. Crossref, Medline, Google Scholar
88 Slavin RE , de Groot WJ . Pathology of the lung in Behçet’s disease: case report and review of the literature. Am J Surg Pathol 1981;5(8):779–788. Crossref, Medline, Google Scholar
89 Chae EJ , Do KH , Seo JB , et al. . Radiologic and clinical findings of Behçet disease: comprehensive review of multisystemic involvement. RadioGraphics 2008;28(5):e31. Link, Google Scholar
90 Grenier P , Bletry O , Cornud F , Godeau P , Nahum H . Pulmonary involvement in Behcet disease. AJR Am J Roentgenol 1981;137(3):565–569. Crossref, Medline, Google Scholar
91 Lee J , Noh JW , Hwang JW , et al. . Successful cyclophosphamide therapy with complete resolution of pulmonary artery aneurysm in Hughes-Stovin syndrome patient. Clin Rheumatol 2008;27(11):1455–1458. Crossref, Medline, Google Scholar
92 Roberts DH , Jimenez JF , Golladay ES . Multiple pulmonary artery aneurysms and peripheral venous thromboses—the Hughes Stovin syndrome: report of a case in a 12-year-old boy and a review of the literature. Pediatr Radiol 1982;12(4):214–216. Crossref, Medline, Google Scholar
93 Ketchum ES , Zamanian RT , Fleischmann D . Angiography of pulmonary artery aneurysms in Hughes-Stovin syndrome. AJR Am J Roentgenol 2005;185(2):330–332. Crossref, Medline, Google Scholar
94 Reimold WV , Emmrich J , Harmjanz D , Kochsiek K . Multiple aneurysms of the pulmonary artery following recurrent septic pulmonary embolism (Hughes-Stovin syndrome): report of 1 case [in German]. Arch Klin Med 1968;215(1):1–18. Medline, Google Scholar
95 Franks TJ , Koss MN . Pulmonary capillaritis. Curr Opin Pulm Med 2000;6(5):430–435. Crossref, Medline, Google Scholar
96 Kim JS , Lee KS , Koh EM , Kim SY , Chung MP , Han J . Thoracic involvement of systemic lupus erythematosus: clinical, pathologic, and radiologic findings. J Comput Assist Tomogr 2000;24(1):9–18. Crossref, Medline, Google Scholar
97 Zamora MR , Warner ML , Tuder R , Schwarz MI . Diffuse alveolar hemorrhage and systemic lupus erythematosus: clinical presentation, histology, survival, and outcome. Medicine (Baltimore) 1997;76(3):192–202. Crossref, Medline, Google Scholar
98 Kim EA , Lee KS , Johkoh T , et al. . Interstitial lung diseases associated with collagen vascular diseases: radiologic and histopathologic findings. RadioGraphics 2002;22(spec no):S151–S165. Link, Google Scholar
99 Germain MJ , Davidman M . Pulmonary hemorrhage and acute renal failure in a patient with mixed connective tissue disease. Am J Kidney Dis 1984;3(6):420–424. Crossref, Medline, Google Scholar
100 Sanchez-Guerrero J , Cesarman G , Alarcón-Segovia D . Massive pulmonary hemorrhage in mixed connective tissue diseases. J Rheumatol 1989;16(8):1132–1134. Medline, Google Scholar
101 Torralbo A , Herrero JA , Portolés J , Barrientos A . Alveolar hemorrhage associated with antineutrophil cytoplasmic antibodies in rheumatoid arthritis. Chest 1994;105(5):1590–1592. Crossref, Medline, Google Scholar
102 Haas C . Pulmonary hypertension associated with systemic lupus erythematosus. Bull Acad Natl Med 2004;188(6):985–997; discussion 997. Medline, Google Scholar
103 Pope J . An update in pulmonary hypertension in systemic lupus erythematosus: do we need to know about it? Lupus 2008;17(4):274–277. Crossref, Medline, Google Scholar
104 Choi HK , Merkel PA , Walker AM , Niles JL . Drug-associated antineutrophil cytoplasmic antibody-positive vasculitis: prevalence among patients with high titers of antimyeloperoxidase antibodies. Arthritis Rheum 2000;43(2):405–413. Crossref, Medline, Google Scholar
105 Dolman KM , Gans RO , Vervaat TJ , et al. . Vasculitis and antineutrophil cytoplasmic autoantibodies associated with propylthiouracil therapy. Lancet 1993;342(8872):651–652. Crossref, Medline, Google Scholar
106 Voorburg AM , van Beek FT , Slee PH , Seldenrijk CA , Schramel FM . Vasculitis due to gemcitabine. Lung Cancer 2002;36(2):203–205. Crossref, Medline, Google Scholar
107 Nicolls MR , Terada LS , Tuder RM , Prindiville SA , Schwarz MI . Diffuse alveolar hemorrhage with underlying pulmonary capillaritis in the retinoic acid syndrome. Am J Respir Crit Care Med 1998;158(4):1302–1305. Crossref, Medline, Google Scholar
108 Han D , Lee KS , Franquet T , et al. . Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imaging findings. RadioGraphics 2003;23(6):1521–1539. Link, Google Scholar
109 Kumar K , Holden WE . Drug-induced pulmonary vascular disease: mechanisms and clinical patterns. West J Med 1986;145(3):343–349. Medline, Google Scholar
110 Lombard CM , Colby TV , Elliott CG . Surgical pathology of the lung in anti-basement membrane antibody-associated Goodpasture’s syndrome. Hum Pathol 1989;20(5):445–451. Crossref, Medline, Google Scholar
111 Anantham D , Chan KP , Chuah KL , Vathsala A , Eng P . Pulmonary capillaritis in IgA nephropathy. South Med J 2007;100(6):605–607. Crossref, Medline, Google Scholar
112 Harland RW , Becker CG , Brandes JC , Fritsche C , Rosenzweig DY . Immunoglobulin A (IgA) immune complex pneumonitis in a patient with IgA nephropathy. Ann Intern Med 1992;116(3):220–222. Crossref, Medline, Google Scholar

Article History

Received January 16, 2009; revision requested March 24; revision received April 9; accepted May 8; final version accepted June 1; final review by K.S.L. December 10.
Published online: Apr 8 2010
Published in print: May 2010

Vol. 255, No. 2

Abbreviations

Abbreviations:
ANCA	antineutrophil cytoplasmic antibody
CSS	Churg-Strauss syndrome
DAH	diffuse alveolar hemorrhage
GGO	ground-glass opacity
Ig	immunoglobulin
SLE	systemic lupus erythematosus

Authors stated no financial relationship to disclose.

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