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The lung in systemic vasculitis: radiological patterns and differential diagnosis.

Br J Radiol

September 2016

6 Department of Neuroscience and Imaging, Section of Diagnostic Imaging and Therapy-Radiology Division, "G. d'Annunzio" University, Chieti, Italy.

The respiratory system may be involved in all systemic vasculitides, although with a variable frequency. The aim of our review is to describe radiographic and high-resolution CT (HRCT) findings of pulmonary vasculitides and to correlate radiological findings with pathological results. Lung disease is a common feature of antineutrophil cytoplasmic autoantibody-associated small-vessel vasculitides, including granulomatosis with polyangiitis (Wegener's), eosinophilic granulomatosis with polyangiitis (Churg-Strauss) and microscopic polyangiitis.

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We present the case of a patient with autoimmune chronic hepatitis and anti-LKM antibodies, who developed associated autoimmune diseases, cyclic nodose erythema, bilateral peripheric paralysis, idiopathic thrombocytopenic purpura and diabetes mellitus. We describe the first signs of the disease and how three different forms can be differentiated depending on the type of autoantibodies present in the patients' serum. Finally, we list several forms of presentation of the disease, the potential clinical associations with other autoimmune processes and the potential immunological basis for the development of the hepatic lesion.

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Comparative studies on the effectiveness of aspiration puncture of the thyroid gland and detection of autoantibodies to its tissue were carried out in 523 patients operated for nodose non-toxic goitre and living in the different goitre-endemic areas. The puncture results and autoantibody detection (before surgery) were compared with the histological findings. It is concluded that the aspiration puncture more adequately than autoantibody detection reflects the histological type of autoagression in endemic goitre combined with phenomena of autoimmunity to the thyroid gland tissue.

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