Goodpasture syndrome: pulmonary manifestations
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Right IJ CVC tip projects over the SVC. There is diffuse patchy groundglass opacity within both lungs predominately within the upper lobes and apical lower lobes with relative sparing of the bases. Compared with the prior examination this has improved within the right lung but is more confluent within the left lung, with infiltrates seen both centrally and peripherally. No interlobular septal thickening or nodules. The airways are normal. Pleural spaces are clear.
No pericardial effusion. No thoracic lymphadenopathy. No suspicious osseous lesions.
Conclusion: Diffuse alveolar infiltrates predominately within the upper lobes and apical lower lobes appear more confluent on the left and improved on the right compared previous imaging. Given the patient's history, appearances are in keeping with pulmonary haemorrhage.
1 case question available
Diagnosis of Goodpasture syndrome was established with a renal biopsy showing anti-glomerular basement membrane antibody.
This disease is more common in men than women and haemoptysis is a dominant clinical symptom.
Differentials for airspace opacification, such as in this case, would include:
- diffuse pulmonary haemorrhage:
- Goodpasture's syndrome, Wegner's granulomatosis, systemic lupus erythematosus, Behçet's syndrome, bleeding diatheses, among others
- infection (atypical, such as PCP, influenza)
- non-cardiogenic pulmonary oedema