If multiple , are they focally located or diffusely seen in multiple lobes of both lungs?
Is are the characteristics of the cavity?
Is the cavity wall thick or thin?
Is the interior lining nodular, shaggy, or smooth?
Are there any other associated radiographic abnormalities?
Urine routine-protein 2+, 3-5 RBCs
DC P66 L 32 E2
Hb 12.8 g
Urea -17 mg
Creatinine 0.8 mg
HIV – NR
SPUTUM AFB negative
Sputum c/s no growth
RF – neg
ANA – Neg
ENT OPINION : Polyp from Lt middle meatus, VLS-normal
FNAC OF A NODULE(CT GUIDED)
2.PULMONARY LANGERHANS CELL HISTIOCYTOSIS
P-ANCA … POSITIVE Approximately 90% of patients with active Wegener’s granulomatosis have a positive antiproteinase-3 ANCA. A small percentage of patients with Wegener’s granulomatosis may have antimyeloperoxidase rather than antiproteinase-3 antibodies.
Points in favour
Paranasal sinus involvement
Granulomatous, necrotizing, small & medium vessel vasculitis
Any age (40-55 yrs.)
Frequency of 3 per 100,000 persons
RENAL -Microscopic hematuria, proteinuria, and rapidly progressive RF
Mononeuritis multiplex or CNS involvement with or without pachymeningitis
ANCA (180pt., 96%with severe dis.,83%with limited dis.)
Lung biopsy yield 91% of cases
Upper airway biopsy yield only 21%of cases
Renal biopsy:focal, segmental necrotizing, crescentic glomerulonephritis with few to no immune complexes
ANCA plays a central role
Antibodies directed against certain cytoplasmic proteins in neutrophils and monocytes
Two major categories based on IF– C & P ANCA
Present in high percentage in systemic vasculitis
Kallenberg CGM et al. (2006) Mechanisms of Disease: pathogenesis and treatment of ANCA-associated vasculitides Nat Clin Pract Rheumatol 2: 661 – 670 doi:10.1038/ ncprheum0355 Figure 1 Cytoplasmic components of ethanol-fixed neutrophils, stained by indirect immunofluorescence, in a serum sample from a patient with active Wegener's granulomatosis and antineutrophil cytoplasmic autoantibodies to proteinase 3