CHEST RADIOLOGY
Case 13:

A 22-year-old female, a smoker, with a short history of respiratory tract infection presents to the emergency with multiple episodes of frank hemoptysis. Following lab results are obtained: S. creatinine 4.5, S. BUN 45, microscopic hematuria and USG findings of enlarged kidneys.
What is the diagnosis following the CT scan?
Which blood test is required to confirm this?
Clcik here for the bigger picture
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 Imaging Findings

CT shows presence of extensive bilateral alveolar exudates (hemorrhage). In view of USG findings, the diagnosis of pulmonary-renal syndrome is suggested, with a possibility of Goodpasture's disease or an unusual presentation of Wegener's or other forms of vasculitis. Anti-GBM antibody titer was strongly positive in this patient confirming the diagnosis of Goodpasture's syndrome.

Discussion

Pulmonary-renal syndrome is a broad category that includes Goodpasture's syndrome, systemic vasculitis, Wegener's granulomatosis, polyarteritis nodosa, and systemic lupus erythematosus.

Goodpasture's syndrome is a rare autoimmune disorder characterized by pulmonary hemorrhage, rapidly progressing glomerulonephritis, and antiglomerular basement membrane (GBM) antibody formation.

Trigger Factors

Trigger factors such as upper respiratory infection or flulike illness, which may damage the pulmonary basement membrane and expose the Goodpasture antigen, causing antibody production in genetically predisposed individuals, cigarette smoking, which may lead to increased lung permeability and induce antibody formation, and exposure to hydrocarbons.


Imaging

Chest X-rays reveal numerous infiltrates. If the hemorrhage is significant enough, the film may show acute respiratory distress syndrome (ARDS). Bronchoscopy reveals hemorrhage from the lung lining. The CT scans are done to rule out other disease processes such as tumors. Renal and lung biopsies, if done, reveal IgG deposition and crescent formation in the glomeruli.

References

http://www.springnet.com/ce/d903a.htm

Dr. Nikhil Cunha, Bandra Holy Family Hospital, Mumbai