Radiologic Diagnostics of Lung Lesions by Granulomatosis with Polyangiitis in the Context of the COVID-19 Pandemic

Abstract

Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, and lung damage in coronavirus infection have many common clinical and radiological symptoms. In the context of the COVID-19 pandemic the ability of a radiologist to differentiate a viral lung lesion from a granulomatous one is relevant due to the difficulty of recognizing them. In order to develop differential radiation diagnostics, a comparative analysis of the computer tomographic picture of lung lesions in each disease was carried out and the leading X-ray patterns were determined. 61 patients with lung damage were examined, including 30 with HPA, 30 with COVID-19 and 1 patient with a combination of these diseases. A total of 74 native computer tomography examinations of the chest organs were accomplished using a Toshiba Aquilion 64 multi-slice CT scanner. It was found that the most informative radiological sign of HPA are nodes, nodules and masses in the lungs, which were detected in 22 (73.3 %) patients, including 11 (36.7 %) with a necrotic cavitation. Ground-glass opacity is often found in both diseases, but COVID-19 is more characterized by a rounded (56.7 %) or polygonal shape (20.0 %) of pathological areas and their peripheral location (70.0 %) mainly in the posterior parts of the lungs, and triangular areas (42.1 %) with a central location (42.1 %) are more often found in HPA. The rapid dynamics of changes in the lungs on control CT scans is of great diagnostic value, which indicates the viral nature of the disease.