Churg–Strauss syndrome is characterised histologically by the presence of necrotising vasculitis and extravascular granulomatous inflammation rich in eosinophils, and clinically by the presence of asthma, fever, blood eosinophilia and peripheral neuropathy. HRCT appearances largely reflect the eosinophilic infiltrate and are largely non-specific. Features include ground-glass opacities, areas of airspace consolidation, centrilobular nodules and airways abnormalities attributable to asthma (Fig. 1). Histologically the airspace disease is due to eosinophilic infiltrate or organising pneumonia. Interlobular septal thickening may be seen as a result of interstitial pulmonary oedema secondary to cardiac involvement. However, a significant proportion (up to 25%) of patients with Churg–Strauss syndrome have few or no imaging abnormalities and imaging is often of little help in making this somewhat elusive diagnosis. Even when HRCT abnormalities exist, they are not specific and the diagnostic accuracy for Churg–Strauss syndrome was less than 50% in one study.
Classic HRCT Findings
• Non-specific patchy ground-glass opacities or consolidation
• Interlobular septal thickening (particularly with cardiac involvement)
• Pleural and pericardial effusion
FIGURE 1 ■ Churg–Strauss syndrome. Spectrum of HRCT features: (A) areas of ground-glass opacification, (B) small cavitating nodules, (C) thickened interlobular septa and (D) an area of airspace opacification, likely to be a peripheral infarct.
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