J Korean Soc Radiol.  2018 Nov;79(5):276-281. 10.3348/jksr.2018.79.5.276.

Sequential CT Findings in Two Cases of Immunoglobulin G4-Related Lung Disease: Focused on Disease Progression

• Lee DK
• Ham SY

• KMID: 2422905
• DOI: http://doi.org/10.3348/jksr.2018.79.5.276

Abstract

Immunoglobulin G4 (IgG4)-related lung disease has been actively studied over the past few years. Radiologic findings of IgG4-related lung disease vary among patients, but there are no long-term follow up studies regarding variations in imaging features over the course of disease progression. In two cases with relatively long-term follow up, diverse early and late computed tomography (CT) findings of IgG4-related lung disease are reviewed in this report. In contrast to nodular or diffuse ground-glass opacity, which was predominantly noted in CT scans at earlier stages of disease, honeycombing and traction bronchiectasis were regarded as late radiologic manifestations. Solid nodules might be visible in both early and late stages; however, development of new solid nodules and enlargement of preexisting nodules could occur during disease progression. Interlobular septal thickening and mediastinal/hilar lymphadenopathy were persistent, even in later stages of the disease. These findings might be useful in making an accurate and timely diagnosis of IgG4-related lung disease.

MeSH Terms

Bronchiectasis
Diagnosis
Disease Progression*
Follow-Up Studies
Humans
Immunoglobulin G
Immunoglobulins*
Lung Diseases*
Lung*
Lymphatic Diseases
Tomography, X-Ray Computed
Traction
Immunoglobulin G
Immunoglobulins

Figure

• 

  Fig. 1 Contrast enhanced serial chest CT scans in a 73-year-old male (case 1) with immunoglobulin G4-related lung disease. A. Spiculated nodular consolidation with air bronchogram is shown in the right upper lobe. B. After 17 months, follow-up chest CT scan reveals a mass larger than 5 cm in the right upper lobe. C. Interlobular septal thickening with satellite nodules are shown in both upper lobes (left), and diffuse and nodular wall thickening of the trachea and esophagus with interval aggravation is simultaneously noted in this CT scan (right).

• 

  Fig. 2 Serial chest CT scans in a 65-year-old male (case 2) with immunoglobulin G4-related lung disease. A. Multifocal diffuse and patchy ground-glass opacities are noted in the bilateral lungs. B. In the follow-up CT taken 1 month later, extensive consolidations with air bronchogram are shown in both lungs with right lung predominancy. C. The last follow-up CT scan taken in 40 months reveals honeycombing and traction bronchiectasis in both basal lungs.

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