PURPOSE:The clinical spectrum of tracheobronchial manifestations of Wegener’s Granulomatosis (WG) has been described qualitatively. The present study was conducted to determine the frequency and preferred location of specific lesions.
METHODS:We conducted a computer-assisted search of the Mayo Clinic, Rochester, MN database and identified 197 patients with documented WG who underwent bronchoscopy at our institution over a 10-year period (January 1995 - December 2005).
RESULTS:The median age was 54 years (range: 16- 87), 51% were female. 149 patients (76%) were c-ANCA positive, and 31 (16%) were p-ANCA positive. 139 patients (71%) had abnormalities noted on bronchoscopy. 21 patients had alveolar hemorrhage. Of the remaining 118, laryngeal involvement was seen in 20 patients (17%), most commonly inflammation. Subglottic stenosis was seen in 41 (35%), other tracheal disease was seen in 60 (51%), predominantly inflammation. Diffuse inflammation was noted in the right bronchial tree in 23 patients (19%), and in 24 patients (20%) on the left. The right mainstem/bronchus intermedius was stenosed in 21 patients (18%). Abnormalities with a predominance of stenosis or occlusion were noted in 30 patients (25%) in the right upper lobe, in 17 (14%) in the right middle lobe, and in 11 (9%) in the right lower lobe. The left mainstem was stenosed in 23 patients (19%). Lesions were identified in 26 patients (22%) in the left upper lobe, in 5 patients (5%) in the lingua and in 10 patients (8%) in the left lower lobe; the most common lesions were stenosis or occlusion.
CONCLUSION:Tracheobronchial abnormalities are common and heterogenous. In this series active inflammation was noted most commonly in the trachea. Stenosis and occlusion were most commonly seen at the level of lobar bronchi; an upper lobe predominance without side preference was noted.
CLINICAL IMPLICATIONS:Tracheobronchial abnormalities are common in WG. Thorough bronchoscopic evaluation of the entire bronchial tree may be warranted in affected patients.
DISCLOSURE:Lorenzo Klein, No Financial Disclosure Information; No Product/Research Disclosure Information