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Case Reports in Radiology
Volume 2015, Article ID 516437, 5 pages
http://dx.doi.org/10.1155/2015/516437
Case Report

Granulomatosis with Polyangiitis Presenting with Coronary Artery and Pericardial Involvement

1University of Pittsburgh Medical Center, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA
2University of Pittsburgh Medical Center, Department of Pathology A711 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA

Received 16 September 2015; Revised 6 November 2015; Accepted 30 November 2015

Academic Editor: Ercan Kocakoc

Copyright © 2015 Rohit Dewan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Granulomatosis with polyangiitis is a systemic disease resulting in necrotizing vasculitis of small- and medium-sized vessels. Cardiac involvement is rare and when present usually manifests with pericarditis and coronary artery vasculitis. We report here a case of granulomatosis with polyangiitis involving the native coronary arteries, bypass graft, and pericardium with interesting imaging findings on contrast-enhanced CT and MRI. A 57-year-old man with a history of chronic headaches presented to the emergency room with syncope. Contrast-enhanced CT demonstrated extensive soft tissue attenuation around the native coronary arteries and bypass graft. Contrast-enhanced MRI demonstrated enhancing nodular soft tissue surrounding the coronary arteries, bypass graft, and pericardium. Pericardial biopsy revealed a necrotizing granulomatous pericarditis with vasculitis concerning for granulomatosis with polyangiitis. The patient demonstrated MPO-positive and PR-3 negative serologies. After being discharged on rituximab and prednisone, follow-up CT 3 years later showed significant improvement of the soft tissue thickening surrounding the coronary arteries, bypass graft, and pericardium.