대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제82권4호
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  • Pages.826-837
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  • 2021
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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흉부에서 발생한 IgG4 연관 질환: 영상 소견 및 감별진단

Immunoglobulin G4-Related Disease in the Thorax: Imaging Findings and Differential Diagnosis

  • 김유경 (이화여자대학교 의과대학 영상의학교실) ;
  • 최혜영 (이화여자대학교 목동병원 영상의학과)
  • Yookyung Kim (Department of Radiology, Ewha Womans University, College of Medicine) ;
  • Hye Young Choi (Department of Radiology, Ewha Womans University Mokdong Hospital)
  • 투고 : 2021.05.04
  • 심사 : 2021.06.15
  • 발행 : 2021.07.01
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초록

면역글로불린G4 연관 질환(immunoglobulin G4-related disease; 이하 IgG4-RD)는 IgG4를 생산하는 면역세포에 의한 만성 염증성질환으로, 주로 타액선, 누액선, 안와, 췌장, 담도, 간, 신장, 후복막, 대동맥, 폐, 림프절 등 다양한 장기를 침범하고, 조직학적으로 IgG4 양성 형질세포와 림프구의 침윤 및 나선형의 섬유화(storiform fibrosis), 폐색정맥염(obliterative phlebitis)을 특징으로 한다. IgG4-RD의 흉부 침범에서 가장 흔한 소견은 종격동 림프절 비대와 폐의 림프관주위 간질 비후이다. 폐의 기관지혈관주위 간질 비후와 우측 척추곁 밴드형 연부조직은 IgG4-RD의 특징적 소견이고, 그 외에도 폐결절 혹은 종괴, 간유리음영, 폐포 간질비후, 흉막삼출 및 비후, 흉벽이나 종격동 종괴, 대동맥과 관상동맥의 혈관염이 발생할 수 있다. 영상의학적으로는 악성 종양이나 감염 및 다양한 염증성질환과의 감별진단이 필요하다. 본 연구에서는 흉부에서 발생하는 IgG4-RD의 영상 소견과 감별진단에 대해 기술하였다.

Immunoglobulin G4-related disease (IgG4-RD) is a chronic inflammatory condition involving multiple organs, including the salivary or lacrimal glands, orbit, pancreas, bile duct, liver, kidney, retroperitoneum, aorta, lung, and lymph nodes. It is histologically characterized by tissue infiltration with lymphocytes and IgG4-secreting plasma cells, storiform fibrosis, and obliterative phlebitis. In the thoracic involvement of IgG4-RD, mediastinal lymphadenopathy and perilymphangitic interstitial thickening of the lung are the most common findings. Peribronchovascular and septal thickening and paravertebral band-like soft tissue are characteristic findings of IgG4-RD. Other findings include pulmonary nodules or masses, ground-glass opacity, alveolar interstitial thickening, pleural effusion or thickening, mass in the chest wall or mediastinum, and arteritis involving the aorta and coronary artery. Radiologic differential diagnosis of various malignancies, infections, and inflammatory conditions is needed. In this review, we describe the imaging findings of IgG4-RD and the radiologic differential diagnoses in the thorax.

키워드

과제정보

All authors appreciate Eun Ju Chun MD from Seoul National University Bundang Hospital and Yoon Kyung Kim MD from Samsung Medical Center who provided interesting cases for this review article.

참고문헌

  1. Kamisawa T, Zen Y, Pillai S, Stone JH. IgG4-related disease. Lancet 2015;385:1460-1471 https://doi.org/10.1016/S0140-6736(14)60720-0
  2. Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med 2012;366:539-551 https://doi.org/10.1056/NEJMra1104650
  3. Corcoran JP, Culver EL, Anstey RM, Talwar A, Manganis CD, Cargill TN, et al. Thoracic involvement in IgG4-related disease in a UK-based patient cohort. Respir Med 2017;132:117-121 https://doi.org/10.1016/j.rmed.2017.10.005
  4. Zhang Z, Guan W, Lin Q, Yu W. Thoracic paravertebral involvement in patients with IgG4-related disease: CT and MR imaging findings. Rheumatology (Oxford) 2020;59:3878-3885 https://doi.org/10.1093/rheumatology/keaa254
  5. Kanno A, Nishimori I, Masamune A, Kikuta K, Hirota M, Kuriyama S, et al. Nationwide epidemiological survey of autoimmune pancreatitis in Japan. Pancreas 2012;41:835-839 https://doi.org/10.1097/MPA.0b013e3182480c99
  6. Zen Y, Nakanuma Y. IgG4-related disease: a cross-sectional study of 114 cases. Am J Surg Pathol 2010;34:1812-1819 https://doi.org/10.1097/PAS.0b013e3181f7266b
  7. Ghazale A, Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, et al. Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol 2007;102:1646-1653 https://doi.org/10.1111/j.1572-0241.2007.01264.x
  8. Strehl JD, Hartmann A, Agaimy A. Numerous IgG4-positive plasma cells are ubiquitous in diverse localised non-specific chronic inflammatory conditions and need to be distinguished from IgG4-related systemic disorders. J Clin Pathol 2011;64:237-243 https://doi.org/10.1136/jcp.2010.085613
  9. Umehara H, Okazaki K, Masaki Y, Kawano M, Yamamoto M, Saeki T, et al. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011. Mod Rheumatol 2012;22:21-30 https://doi.org/10.3109/s10165-011-0571-z
  10. Wallace ZS, Naden RP, Chari S, Choi H, Della-Torre E, Dicaire JF, et al. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease. Arthritis Rheumatol 2020;72:7-19
  11. Ogoshi T, Kido T, Yatera K, Oda K, Nishida C, Yamasaki K, et al. Incidence and outcome of lung involvement in IgG4-related autoimmune pancreatitis. Respirology 2015;20:1142-1144 https://doi.org/10.1111/resp.12599
  12. Zen Y, Inoue D, Kitao A, Onodera M, Abo H, Miyayama S, et al. IgG4-related lung and pleural disease: a clinicopathologic study of 21 cases. Am J Surg Pathol 2009;33:1886-1893 https://doi.org/10.1097/PAS.0b013e3181bd535b
  13. Khosroshahi A, Wallace ZS, Crowe JL, Akamizu T, Azumi A, Carruthers MN, et al. International consensus guidance statement on the management and treatment of IgG4-related disease. Arthritis Rheumatol 2015;67:1688-1699 https://doi.org/10.1002/art.39132
  14. Cheuk W, Chan JK. Lymphadenopathy of IgG4-related disease: an underdiagnosed and overdiagnosed entity. Semin Diagn Pathol 2012;29:226-234 https://doi.org/10.1053/j.semdp.2012.07.001
  15. Kurowecki D, Patlas MN, Haider EA, Alabousi A. Cross-sectional pictorial review of IgG4-related disease. Br J Radiol 2019;92:20190448
  16. Park K, Choi YW, Kang BK, Lee JY, Park JS, Shin SJ, et al. Systemic manifestations of immunoglobulin G4-related disease: a pictorial essay. J Korean Soc Radiol 2021;82:575-588 https://doi.org/10.3348/jksr.2020.0141
  17. Yasokawa N, Shirai R, Tanaka H, Kurose K, Oga T, Oka M. Thoracoscopic findings in IgG4-related pleuritis. Intern Med 2020;59:257-260 https://doi.org/10.2169/internalmedicine.3031-19
  18. Kim DH, Koh KH, Oh HS, Kim SJ, Kang SH, Jung BW, et al. A case of immunoglobulin g4-related disease presenting as a pleural mass. Tuberc Respir Dis (Seoul) 2014;76:38-41 https://doi.org/10.4046/trd.2014.76.1.38
  19. Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. IgG4-related cardiovascular disease. The emerging role of cardiovascular imaging. Eur J Radiol 2017;86:169-175 https://doi.org/10.1016/j.ejrad.2016.11.012
  20. Oyama-Manabe N, Yabusaki S, Manabe O, Kato F, Kanno-Okada H, Kudo K. IgG4-related cardiovascular disease from the aorta to the coronary arteries: multidetector CT and PET/CT. Radiographics 2018;38:1934-1948 https://doi.org/10.1148/rg.2018180049
  21. Inoue D, Zen Y, Abo H, Gabata T, Demachi H, Yoshikawa J, et al. Immunoglobulin G4-related periaortitis and periarteritis: CT findings in 17 patients. Radiology 2011;261:625-633 https://doi.org/10.1148/radiol.11102250
  22. Xiao J, Hu B, Cheng D, Shi H, Xiu Y. Features of IgG4-related lung disease on 18F-FDG PET/computed tomography imaging. Nucl Med Commun 2020;41:933-941 https://doi.org/10.1097/MNM.0000000000001238
  23. Rossi GM, Rocco R, Accorsi Buttini E, Marvisi C, Vaglio A. Idiopathic retroperitoneal fibrosis and its overlap with IgG4-related disease. Intern Emerg Med 2017;12:287-299 https://doi.org/10.1007/s11739-016-1599-z
  24. Keelan E, McCorkell A, Kelly M, Shivashankar G, O'Rouke D. A curious case of granulomatosis with polyangitis. Ulster Med J 2021;90:50-51