Whipple disease (thoracic manifestations)

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Thoraco-pulmonary manifestations of Whipple disease are uncommon and present in the late stages of the disease.

Epidemiology

Lung involvement is seen in 35-60% of patients with gastrointestinal whipple disease.

Clinical presentation

Majority of patients present with non-specific pulmonary and general symptoms like a chronic non-productive cough, pleuritic chest pain, dyspnea, progressive weight loss, anorexia, malaise, arthralgia and intermittent fever.

Pathology

Grossly there are areas of consolidation around bronchovascular channels which appear similar to sarcoidosis. Microscopically there are periodic acid-Schiff positive inclusion bodies in the macrophages within the lesion.

Radiographic features

Plain radiograph

Various patterns can be observed in pulmonary Whipple disease which may include:

  • diffuse or focal pulmonary infiltrates
  • basal lung opacities
  • nodular lesions
  • pleural adhesions
  • pleural effusion
CT

CT may reveal basal infiltrates, soft tissue nodules, mediastinal and hilar lymphadenopathy.