Vascular Changes

In our patient, granulomas compressed and narrowed many muscular arteries, arterioles, veins, venules, and lymphatics. Granulomas focally destroyed elastic layers and the muscular media. These changes produced pulmonary hypertension. As a result, pulmonary artery blood flow was shunted to the bronchial arteries, which were already enlarged to support the granulomatous inflammation of the airway walls.

The outer elastic layer of this muscular artery has been destroyed by granulomas on two sides of this artery. Its lumen is narrowed, but not occluded. Elastic van Gieson stain.

A peripheral bronchovascular bundle has been markedly distorted by granulomas and fibrous tissue. The bronchiole (B) at the right has a granuloma protruding into the lumen (arrow). The artery to the left (arrows) is surrounded and occluded by granulomas that have destroyed most of the elastic layers. Elastic van Gieson stain.

This small vein has intimal fibrosis that narrows a branch. At the right end, granulomas have destroyed the elastic tissue and narrowed the lumen. The surrounding alveoli, which are partly filled with blood, are normal. Elastic van Gieson stain

Here, another vein disappears into a nodular collection of granulomas. Elastic van Gieson stain

Clinical summary Image 5

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