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Necrotizing Granuloma of the Lung: Imaging Characteristics and Imaging-Guided Diagnosis

Rennae Thiessen1, Jean M. Seely1, Frederick R. K. Matzinger1, Prachi Agarwal1,2, Karen L. Burns3, Carole J. Dennie1 and Rebecca Peterson1

1 Department of Diagnostic Imaging, The Ottawa Hospital, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada.
2 Present address: Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI.
3 Department of Pathology, The Ottawa Hospital, Ottawa, ON, Canada.


Figure 1
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  		Fig. 1A —74-year-old woman with necrotizing granuloma proven with imaging-guided core needle biopsy. Axial CT scan shows spiculated 2.7-cm lesion in right upper lobe surrounded by emphysema.

 

Figure 2
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  		Fig. 1B —74-year-old woman with necrotizing granuloma proven with imaging-guided core needle biopsy. Axial CT scan at same level as A obtained at mediastinal setting shows homogeneous soft-tissue attenuation of lesion.

 

Figure 3
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  		Fig. 2A —36-year-old woman with necrotizing granuloma of lung proven with core needle biopsy. Axial CT scan shows lobulated 3.4-cm mass in left lower lobe with surrounding ground-glass attenuation.

 

Figure 4
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  		Fig. 2B —36-year-old woman with necrotizing granuloma of lung proven with core needle biopsy. Axial CT at same level as A obtained in mediastinal window setting shows mass of homogeneous soft-tissue attenuation contiguous to left hilar adenopathy.

 

Figure 5
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  		Fig. 2C —36-year-old woman with necrotizing granuloma of lung proven with core needle biopsy. Photomicrograph of core needle biopsy specimen shows necrosis (arrows). (H and E, x1)

 

Figure 6
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  		Fig. 2D —36-year-old woman with necrotizing granuloma of lung proven with core needle biopsy. Photomicrograph of histologic section of specimen at higher magnification shows interface of necrosis (arrows) with rim of histiocytes and scattered lymphocytes (arrowheads) in characteristic appearance of necrotizing granuloma. (H and E, x4)

 

Figure 7
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  		Fig. 3A —58-year-old woman with necrotizing granuloma proven with core needle biopsy. Axial CT scan shows solitary smoothly marginated 2-cm cavitary lesion in right lower lobe.

 

Figure 8
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  		Fig. 3B —58-year-old woman with necrotizing granuloma proven with core needle biopsy. Axial CT scan at same level as A in mediastinal window setting shows cavity has variable wall thickness. There is no associated calcification.

 

Figure 9
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  		Fig. 4A —80-year-old man with necrotizing granuloma diagnosed with core needle biopsy. Axial CT scan shows lobulated 2.4-cm lesion with adjacent cylindric bronchiectasis and emphysema in right lower lobe.

 

Figure 10
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  		Fig. 4B —80-year-old man with necrotizing granuloma diagnosed with core needle biopsy. Axial CT scan at same level as A obtained in mediastinal window setting shows multiple eccentric unusual calcifications in lesion, none of which is characteristically benign.

 

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