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Case of the Week 377

What is the most likely diagnosis?

  • 45 year-old male with rhinitis and fever

Frontal chest radiographs 4 months apart

1. Benign metastasizing leiomyomas
2. Alveolar sarcoid
3. Infected bullae
4. Wegener's granulomatosis
5. Alveolar microlithiasis

Additional Images - Two additional chest radiographs spanning 2 more years


Additional Images


Two additional chest radiographs spanning 2 more years



4. Wegener's Granulomatosis



More (Click Discussion Tab)

Wegener's Granulomatosis

General Considerations

  • Hallmarks
    • Small to medium sized systemic vasculitis
    • Granulomatous inflammation
    • Necrosis
  • High C-ANCA association (88%)
    • Not a definitive marker for diagnosis
  • Unknown etiology
  • Incidence of 1 case per 30,000
    • Affects predominantly whites (91%)
    • M>F
    • Mean age at diagnosis = 45

    More ...


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    is an award-winning educational website aimed primarily at medical students and radiology residents-in-training, containing  lectures, handouts, images, Cases of the Week, archives of cases, quizzes, flashcards of differential diagnoses and “most commons” lists, primarily in the areas of chest, GI, GU cardiac, bone and neuroradiology.