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Clinical Problem Solving: Radiology
August 2005

Radiology Quiz Case 2: Diagnosis

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Arch Otolaryngol Head Neck Surg. 2005;131(8):742-743. doi:10.1001/archotol.131.8.742-b

Churg-Strauss syndrome is a systemic vasculitis. There are 3 distinct clinical phases—asthma, tissue eosinophilia, and vasculitis—that occur in many, but not all, patients.1 These phases, and the varied pathologic findings, suggest that the pathophysiologic process of the disorder might evolve over time.

Analysis of tissue biopsy specimens from patients with CSS shows an eosinophil-rich inflammatory infiltrate with granuloma formation in connective tissue and blood vessel walls. Necrotizing vasculitis with fibrinoid changes arises in small to medium-size vessels. It differs from other small to medium-size vessel vasculitides (Wegener granulomatosis and microscopic polyangiitis) clinically because of the presence of asthma and pathologically because of the eosinophilic infiltration of affected tissues.

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