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Abstract

Over 70-95% patients with PR3 ANCA pulmonary vasculitis present with upper respiratory tract symptoms or sings. Nasal activity usually presents with nasal obstruction and chronic refractory infections (rhinosinusitis), commonly manifests as bloody discharge, crusting and local obstruction. Mucopurulent discharge may occur in the acute phase or remission along with other symptoms suggesting sinusitis. In the later observation, saddle nose deformities can occur due to collapse of the nasal septum. Other common destruction areas are the maxillary ostia, erosion of the tubinates or damage of soft palate. The aim of the study was to characterize pathologies of nasal and sinonasal CT scans in patients with PR3 pulmonary ANCA vasculitis and to establish the CT diagnostic criteria for WG. Between 2005-2009 sinonasal CT visualization was performed in 35 patients (19 female, 16 male) with PR3 ANCA positive Wegener?s granulomatosis. Bony destruction of the nasal cavity was revealed in 15 (42.8%) and in 20 (57.1%) of the paranasal sinuses, of the mastoid cells in 7 (20%) and of the orbits in 7 (20%) patients. Sclerosing osteitis of the nasal cavity and paranasal sinuses was observed in 11 (31.4%) and in 24 (68.5%) respectively. Bony thickening of the nasal cavity was shown in 5 (14.2%) patients bilateral, of the paranasal sinuses in 7 (20%) (unilateral in 2 patients and bilateral in 5 patients). In 7 (20%) patients had orbital masses (all unilateral). Septal perforation we observed in 11 (31.4%) patients and saddle nose deformity were observed in 7 (20%) patients. The maxillary sinuses were the most frequently affected. CT imagines may be a useful supplement to clinical and activity scoring of WG disease with pulmonary involvement.

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