Endobronchial Disease

A close-up view of the posterior segmental bronchus (arrow) to the upper lobe shows thickening of its wall and narrowing of the lumen as shown on the last page. Note the scattered parenchymal nodules around the smaller airways and on the pleura.

The airway narrowing caused the patient's worsening airflow obstruction.

This cross section of a thickened airway has been stained with the trichrome stain that colors the collagenous tissue blue. The purple-staining, infiltrating granulomas here are focally separated by fibrous tissue. The narrowed airway has an irregular shape. Most normal wall structures--cartilage, smooth muscle, and elastic tissue--have been destroyed. (The two dark blue circles represent residual cartilage.)

As a consequence of this inflammatory process, treatment might lead to stenosis or bronchiectasis, depending on the degree of fibrosis. Note that the surrounding lung parenchyma is normal.

A view of part of the wall of another airway shows a granuloma protruding into the lumen at the top. In the wall are multiple dilated vascular and lymphatic channels that are supplying the inflammatory tissue. It is probable that erosion of one of these vessels accounted for the terminal pulmonary hemorrhage. Elastic van Gieson stain showing red collagen and black elastic tissue.

Clinical summary Image 3

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