| Histologic features of CGD in the lung are nonspecific, but may include: neutrophil-predominant abscesses or micro-abscesses surrounded by histiocytes; granulomas, which may be suppurative, necrotising or non-necrotising; and chronic diffuse inflammation associated with areas of fibrosis [110,111]. Gastrointestinal tract histology findings in CGD involving the gut are also nonspecific, and may be indistinguishable from IBD [112,113,114,115]. These include mucosal granulomas or microgranulomas and focal inflammation in the form of acute cryptitis, crypt abscess and ulceration, as well as chronic lymphoplasmacytic inflammation and disruption of normal mucosal architecture [113,116]. Eosinophils and pigmented macrophages may be present in inflammatory infiltrates, and the latter are reported to be more suggestive of CGD [112,116]. These findings may occur throughout the gastrointestinal tract, but predominantly affect the lower colorectum and perianal area, with sparing of the upper tract and oesophagus [113,116]. Biopsy findings of CGD-related lesions in skin, lymphoreticular system, liver and bladder may share elements of these nonspecific histologic characteristics of acute and chronic inflammation, with granulomas and occasional visualisation of microorganisms [117].
Radiologic appearances of lung infection in CGD can be varied, and include pulmonary nodules, ground-glass opacities, focal consolidation and masses, with or without cavities, abscesses, effusion or chest wall involvement where infection is invasive [118,119]. Post-infectious and inflammatory complications can also be varied on chest imaging, and may demonstrate fibrosis, septal thickening, bronchiectasis, and emphysema [118,119]. In the gut, patients may again demonstrate nonspecific radiologic findings of wall thickening, dilatation, or mucosal enhancement with a predominance of lower tract and perianal disease (fistulae, fat stranding and abscesses), and endoscopy may or may not show active inflammatory changes [120]. Imaging of CGD lymphadenitis shows nonspecific tomographic appearances of enlarged and contrast-enhanced lymph nodes with or without central necrosis, which sonographically may have thick septations and internal debris; calcification may be seen in chronically inflamed nodes [121]. In the genitourinary tract, wall thickening may be demonstrated in the bladder and ureteric tracts, sometimes with evidence of obstruction (e.g., hydronephrosis) or scarring and calcification [121,122]. Furthermore, complications of CGD in liver, spleen, skin or soft tissue, muscle, bone and central nervous system may demonstrate nonspecific radiologic changes [121]. |