Table of Contents
Washington University Experience | VASCULAR | Infarct - Venous | 6A0 Case 6 History
Case 6 History ---- This man presented in 1963 with chronic leg ulcers, a cavity in right lung, and x-ray evidence of chronic sinusitis. On review of the biopsies of the leg ulcers, an arteritis away from the ulcer was seen. In 1967 a pneumonectomy was performed after severe pulmonary hemorrhage from a single 8 cm. in diameter thick walled cystic cavity which, on histologic examination, consisted of granulomatous inflammation with occasional giant cells. The vessels in the lesions showed necrotizing vasculitis. The area away from the lesion revealed a capillaritis on the alveolar wall. He also has had esophageal ulcers in 1967 which, at autopsy, revealed fibrosis of the wall with acute and chronic inflammation areas with absence of mucosa. A chronic mouth ulcer and the maxillary sinus showed chronic inflammation without granulomatous inflammation. ---- At autopsy the brain weighed 1320 g. The kidneys, left lung and spleen had no lesions. The dural sinus thrombosis was felt to be due to a hypercoagulable state. The best diagnosis made at that time of the overall process was limited Wegener’s granulomatosis on the basis of a proven necrotizing granulomatous pulmonary lesion with cutaneous and pulmonary vasculitis. The etiology of the esophageal fibrosis remained unestablished by the autopsy findings. Only chronic inflammation was documented in the single mouth ulcer. This with the absences of kidney lesions and the long survival were thought to separate this process from classical Wegener’s granulomatosis.
