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Chest Radiographic and CT Manifestations of Chronic Granulomatous Disease in Adults

Myrna C. B. Godoy1,2, Patrick M. Vos1, Peter L. Cooperberg1, Carmen P. Lydell1, Peter Phillips3 and Nestor L. Müller4

1 Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
2 Present address: Department of Radiology, New York University School of Medicine, 560 First Ave., IRM 236, New York, NY 10016.
3 Division of Infectious Diseases, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
4 Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.


Figure 1
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  		Fig. 1A —26-year-old man with X-linked chronic granulomatous disease presenting with nonproductive cough and pleuritic chest pain. Chest radiograph shows bilateral areas of consolidation.

 

Figure 2
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  		Fig. 1B —26-year-old man with X-linked chronic granulomatous disease presenting with nonproductive cough and pleuritic chest pain. High-resolution CT scan shows scarring, traction bronchiectasis, areas of decreased attenuation and vascularity, and emphysema in the upper lobes.

 

Figure 3
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  		Fig. 1C —26-year-old man with X-linked chronic granulomatous disease presenting with nonproductive cough and pleuritic chest pain. High-resolution CT scan shows area of consolidation in the right middle lobe with adjacent centrilobular nodules, focal interlobular septal thickening, and ground-glass opacity. A pulmonary nodule is seen in the superior segment of right lower lobe.

 

Figure 4
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  		Fig. 1D —26-year-old man with X-linked chronic granulomatous disease presenting with nonproductive cough and pleuritic chest pain. Expiratory CT scan shows extensive areas of air trapping.

 

Figure 5
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  		Fig. 1E —26-year-old man with X-linked chronic granulomatous disease presenting with nonproductive cough and pleuritic chest pain. Follow-up high-resolution CT scan, performed 2 months after A–D, after antibiotic therapy, shows minimal change in the extent of consolidation in the right middle lobe. Areas of decreased attenuation and vascularity are again noted bilaterally.

 

Figure 6
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  		Fig. 1F —26-year-old man with X-linked chronic granulomatous disease presenting with nonproductive cough and pleuritic chest pain. CT scan (5-mm slice thickness) obtained 10 months after E shows decrease in extent of the consolidation in the right middle lobe and decrease in the pulmonary nodule in the right lower lobe.

 

Figure 7
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  		Fig. 2A —22-year-old man with history of chronic granulomatous disease presenting with fever and productive cough for 10 days. Chest radiograph shows retrocardiac area of consolidation.

 

Figure 8
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  		Fig. 2B —22-year-old man with history of chronic granulomatous disease presenting with fever and productive cough for 10 days. CT scan (5-mm slice thickness) shows consolidation with surrounding ground-glass opacities in the left lower lobe.

 

Figure 9
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  		Fig. 2C —22-year-old man with history of chronic granulomatous disease presenting with fever and productive cough for 10 days. Follow-up CT scan (5-mm slice thickness) performed 1 month after A and B shows progression of the consolidation in the left upper and lower lobes associated with small pulmonary nodules and small left pleural effusion.

 

Figure 10
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  		Fig. 2D —22-year-old man with history of chronic granulomatous disease presenting with fever and productive cough for 10 days. Follow-up CT scan (5-mm slice thickness) performed 1 month after A and B shows progression of the consolidation in the left upper and lower lobes associated with small pulmonary nodules and small left pleural effusion.

 

Figure 11
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  		Fig. 2E —22-year-old man with history of chronic granulomatous disease presenting with fever and productive cough for 10 days. Chest radiograph performed 7 days after C and D shows extensive consolidation in the mid and lower left lung zones. Blood culture and open lung biopsy were positive for Burkholderia cepacia.

 

Figure 12
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  		Fig. 3A —29-year-old man with chronic granulomatous disease presenting with chest pain and fever. Chest radiograph shows reticulonodular opacities and enlargement of main pulmonary artery.

 

Figure 13
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  		Fig. 3B —29-year-old man with chronic granulomatous disease presenting with chest pain and fever. CT scan (5-mm slice thickness) at level of inferior pulmonary veins shows areas of scarring, traction bronchiectasis, emphysema, areas of decreased attenuation and vascularity, and bilateral ill-defined pulmonary nodules measuring up to 7 mm in diameter.

 

Figure 14
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  		Fig. 3C —29-year-old man with chronic granulomatous disease presenting with chest pain and fever. Follow-up chest CT scan (5-mm slice thickness) performed 10 months after B shows resolution of the small pulmonary nodules with persistence of fibrotic changes.

 

Figure 15
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  		Fig. 3D —29-year-old man with chronic granulomatous disease presenting with chest pain and fever. High-resolution CT scan at the level of the upper lobes, performed 7 months after C, shows bilateral scarring with traction bronchiectasis associated with reticulation, emphysema, and areas of decreased attenuation and vascularity.

 

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