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Granulomatous Disease
Todd Michael Danziger, MD; Hollins Clark, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        TERMINOLOGY

        • Definitions

          • Granulomatous disease characterized by formation of granulomas, either infectious or noninfectious
            • Sarcoidosis
              • Multisystem granulomatous disease of unknown etiology characterized by formation of noncaseating granulomas
                • Pulmonary and lymph node involvement most common
                • Can also involve heart and other tissues
            • Mycobacterial infection
              • Tuberculosis most commonly characterized by pulmonary granulomas, which demonstrate high levels of glucose uptake
                • Can spread to any organ by hematogenous or lymphatic dissemination
            • ANCA-associated vasculitis
              • Heterogeneous group of diseases, including granulomatosis with polyangiitis (formerly Wegener granulomatosis), characterized by necrotizing small vessel inflammation
                • Pulmonary, sinonasal, and renal involvement most common
            • Langerhans cell histiocytosis
              • Rare multisystem histiocytosis characterized by clonal proliferation of Langerhans cells
                • Hepatic, splenic, osseous, &/or pulmonary involvement most common
            • Chronic granulomatous disease
              • Congenital immunodeficiency characterized by recurrent bacterial and fungal infections with granuloma formation
                • Pulmonary involvement most common
            • Large vessel vasculitis
              • Group of vasculitides, including Takayasu and giant cell arteritis, characterized by granulomatous inflammation of large vessels, predominantly aorta and its major branches
            • Erdheim-Chester disease
              • Rare non-Langerhans cell histiocytosis characterized by xanthomatous tissue infiltration
                • Osseous and CNS involvement most common

        IMAGING

        • F-18 FDG PET/CT Findings

          • C-11 Methionine PET Findings

            • Radiographic Findings

              • CT Findings

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • Microscopic Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Image Interpretation Pearls

                              Selected References

                              1. Agarwal KK et al: 18F-fluorodeoxyglucose PET/CT in Langerhans cell histiocytosis: spectrum of manifestations. Jpn J Radiol. 34(4):267-76, 2016
                              2. Bucerius J: Monitoring vasculitis with 18F-FDG PET. Q J Nucl Med Mol Imaging. 60(3):219-35, 2016
                              3. White TV et al: Non-sclerotic bone involvement in Erdheim-Chester: PET/CT and MRI findings in a 15-year-old boy. Pediatr Radiol. 46(9):1345-9, 2016
                              4. Soussan M et al: FDG-PET/CT in patients with ANCA-associated vasculitis: case-series and literature review. Autoimmun Rev. 13(2):125-31, 2014
                              5. Vorster M et al: Advances in imaging of tuberculosis: the role of ¹⁸F-FDG PET and PET/CT. Curr Opin Pulm Med. 20(3):287-93, 2014
                              6. Castañer E et al: Imaging findings in pulmonary vasculitis. Semin Ultrasound CT MR. 33(6):567-79, 2012
                              7. Youssef G et al: The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience. J Nucl Med. 53(2):241-8, 2012
                              8. Oksüz MO et al: 18F-FDG PET/CT for the diagnosis of sarcoidosis in a patient with bilateral inflammatory involvement of the parotid and lacrimal glands (panda sign) and bilateral hilar and mediastinal lymphadenopathy (lambda sign). Eur J Nucl Med Mol Imaging. 38(3):603, 2011
                              9. Criado E et al: Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics. 30(6):1567-86, 2010
                              10. Towbin AJ et al: Chronic granulomatous disease. Pediatr Radiol. 40(5):657-68; quiz 792-3, 2010
                              11. Hirschmann JV et al: Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 29(7):1921-38, 2009
                              12. Sundar KM et al: Pulmonary Langerhans cell histiocytosis: emerging concepts in pathobiology, radiology, and clinical evolution of disease. Chest. 123(5):1673-83, 2003
                              13. Yamada Y et al: Fluorine-18-fluorodeoxyglucose and carbon-11-methionine evaluation of lymphadenopathy in sarcoidosis. J Nucl Med. 39(7):1160-6, 1998
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Top Differential Diagnoses

                                    TERMINOLOGY

                                    • Definitions

                                      • Granulomatous disease characterized by formation of granulomas, either infectious or noninfectious
                                        • Sarcoidosis
                                          • Multisystem granulomatous disease of unknown etiology characterized by formation of noncaseating granulomas
                                            • Pulmonary and lymph node involvement most common
                                            • Can also involve heart and other tissues
                                        • Mycobacterial infection
                                          • Tuberculosis most commonly characterized by pulmonary granulomas, which demonstrate high levels of glucose uptake
                                            • Can spread to any organ by hematogenous or lymphatic dissemination
                                        • ANCA-associated vasculitis
                                          • Heterogeneous group of diseases, including granulomatosis with polyangiitis (formerly Wegener granulomatosis), characterized by necrotizing small vessel inflammation
                                            • Pulmonary, sinonasal, and renal involvement most common
                                        • Langerhans cell histiocytosis
                                          • Rare multisystem histiocytosis characterized by clonal proliferation of Langerhans cells
                                            • Hepatic, splenic, osseous, &/or pulmonary involvement most common
                                        • Chronic granulomatous disease
                                          • Congenital immunodeficiency characterized by recurrent bacterial and fungal infections with granuloma formation
                                            • Pulmonary involvement most common
                                        • Large vessel vasculitis
                                          • Group of vasculitides, including Takayasu and giant cell arteritis, characterized by granulomatous inflammation of large vessels, predominantly aorta and its major branches
                                        • Erdheim-Chester disease
                                          • Rare non-Langerhans cell histiocytosis characterized by xanthomatous tissue infiltration
                                            • Osseous and CNS involvement most common

                                    IMAGING

                                    • F-18 FDG PET/CT Findings

                                      • C-11 Methionine PET Findings

                                        • Radiographic Findings

                                          • CT Findings

                                            DIFFERENTIAL DIAGNOSIS

                                              PATHOLOGY

                                              • Microscopic Features

                                                CLINICAL ISSUES

                                                • Presentation

                                                  • Demographics

                                                    • Natural History & Prognosis

                                                      • Treatment

                                                        DIAGNOSTIC CHECKLIST

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Agarwal KK et al: 18F-fluorodeoxyglucose PET/CT in Langerhans cell histiocytosis: spectrum of manifestations. Jpn J Radiol. 34(4):267-76, 2016
                                                          2. Bucerius J: Monitoring vasculitis with 18F-FDG PET. Q J Nucl Med Mol Imaging. 60(3):219-35, 2016
                                                          3. White TV et al: Non-sclerotic bone involvement in Erdheim-Chester: PET/CT and MRI findings in a 15-year-old boy. Pediatr Radiol. 46(9):1345-9, 2016
                                                          4. Soussan M et al: FDG-PET/CT in patients with ANCA-associated vasculitis: case-series and literature review. Autoimmun Rev. 13(2):125-31, 2014
                                                          5. Vorster M et al: Advances in imaging of tuberculosis: the role of ¹⁸F-FDG PET and PET/CT. Curr Opin Pulm Med. 20(3):287-93, 2014
                                                          6. Castañer E et al: Imaging findings in pulmonary vasculitis. Semin Ultrasound CT MR. 33(6):567-79, 2012
                                                          7. Youssef G et al: The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience. J Nucl Med. 53(2):241-8, 2012
                                                          8. Oksüz MO et al: 18F-FDG PET/CT for the diagnosis of sarcoidosis in a patient with bilateral inflammatory involvement of the parotid and lacrimal glands (panda sign) and bilateral hilar and mediastinal lymphadenopathy (lambda sign). Eur J Nucl Med Mol Imaging. 38(3):603, 2011
                                                          9. Criado E et al: Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics. 30(6):1567-86, 2010
                                                          10. Towbin AJ et al: Chronic granulomatous disease. Pediatr Radiol. 40(5):657-68; quiz 792-3, 2010
                                                          11. Hirschmann JV et al: Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 29(7):1921-38, 2009
                                                          12. Sundar KM et al: Pulmonary Langerhans cell histiocytosis: emerging concepts in pathobiology, radiology, and clinical evolution of disease. Chest. 123(5):1673-83, 2003
                                                          13. Yamada Y et al: Fluorine-18-fluorodeoxyglucose and carbon-11-methionine evaluation of lymphadenopathy in sarcoidosis. J Nucl Med. 39(7):1160-6, 1998