Pulmonary involvement in Churg-Strauss syndrome: an analysis of CT, clinical, and pathologic findings

We tried to assess retrospectively thin-section CT findings of Churg-Strauss syndrome (CSS) in 25 patients and to compare these findings with clinical and histopathologic findings. Of 25 patients, 19 (76%) had parenchymal abnormalities at CT; small nodules (n=12; 63%), ground-glass opacity (n=10; 53%), bronchial wall thickening (n=10; 53%), and consolidation (n=8; 42%). Parenchymal abnormalities (n=19) were categorizable as an airway pattern in 11 and an airspace pattern in eight. Patients with an airway pattern (n=5) had obstructive (n=3) or combined (n=2) PFT results, whereas those with an airspace pattern (n=4) had restrictive (n=3) or obstructive (n=1) results. Parenchymal opacities at CT corresponded histologically to areas of eosinophilic pneumonia, necrotizing granulomas, and granulomatous vasculitis; small nodules to eosinophilic bronchiolitis and peribronchiolar vasculitis; and bronchial wall thickening to airway wall eosinophil and lymphocyte infiltration. Patients with airspace pattern responded more readily to treatment than those with airway pattern. CT shows lung parenchymal abnormalities in about three-quarters of CSS patients and these abnormalities can be categorized as airspace or airway patterns. This classification helps predict PFT data, underlying histopathology, and treatment response.