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Atypical bronchial thickening and ulceration: a rare radiological finding in Wegener's granulomatosis

¹ Department of Diagnostic and Interventional Radiology, ² Department of Internal Medicine II, ³ Institute of Pathology, University of Ulm, D-89081 Ulm, Germany

Correspondence: Dr Sandra Pauls, Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Robert-Koch-Str. 8, D-89081 Ulm, Germany. E-mail: sandra.pauls{at}uniklinik-ulm.de

We report the case of a 55-year-old male patient who presented with non-specific pulmonary symptoms (cough, haemoptysis, fever up to 39°C, night sweats and weight loss). After empirical antibiotic therapy prescribed by his primary care physician, the patient showed no improvement in symptoms. Laboratory findings were: elevated C-reactive protein and C-ANCA, leukocytosis and thrombocytosis, and anaemia. Chest radiography showed disseminated nodules bilaterally. On multidetector-row computed tomography (MDCT), the bronchial walls showed a significant thickening and extensive peribronchiolar consolidations. Bronchoscopy revealed diffuse erythema of the tracheobronchial mucosa with diffusely scattered white plaques. Histopathology described a multifocal ulcerative bronchitis with underlying chronic bronchitis. These findings in combination with the laboratory data lead to the diagnosis of Wegener's granulomatosis. Consequently, we started with an immunosuppressive therapy. Chest radiography after 10 days showed marked resolution of the infiltrates. Within 1 month, the patient became asymptomatic.