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Wegener’s Granulomatosis Presenting as Necrosis of the Left Mainstem Bronchus

Department of General, Vascular and Thoracic Surgery 1 Department of Internal Medicine 2 Department of Pathology Benjamin Franklin Medical Center Freie Universitt Berlin Berlin, Germany
For reprint information contact: Paul Schneider, MD Tel: 49 30 8445 2543 Fax: 49 30 8445 2740 email: p.schneider{at}ukbf.fu-berlin.de Department of General, Vascular and Thoracic Surgery, Benjamin Franklin Medical Center, Freie Universitt Berlin, Hindenburgdamm 30, Berlin D-12200, Germany.

A patient with pansinusitis, nasal septum necrosis, and saddle nose deformity showed necrosis of the left mainstem, upper, and lower bronchi, with complete loss of left lung perfusion and ventilation. Pneumonectomy was performed. Histological findings showed extensive necrotizing and granulomatous bronchial inflammation with vasculitis of the bronchial arteries and the pulmonary vein. Wegener’s granulomatosis was diagnosed, despite a negative cytoplasmic pattern of antineutrophil cytoplasmic antibodies and the lack of renal involvement.