Bronchial Arteries: arising from aorta and intercostal arteries
Form plexus in the bronchial wall
Uncommonly affected by pulmonary vasculitis
Pulmonary Arteries: arising from RV
Pulmonary capillaries are located in the alveolar septa (where they participate in gas exchange)
Lung has Two Venous Drainage Systems
Bronchial Veins: uncommonly affected by pulmonary vasculitis
Pulmonary Veins: typically located in the intralobular septa
Diagnosis of Pulmonary Vasculitis
Chest CT
May be abnormal even in the absence of symptoms
Ndoules: with or without cavtation
Ground-glass infiltrates: due to DAH
Airway Stenosis: may be seen in vasculitis syndromes with airway involvement (ie: Wegener’s Granulomatosis)
Mediastinal Lymphadenopathy: uncommon -> usually indicative of malignancy or infecton, instead of vasculitis as the etiology [MEDLINE]
FOB
Useful to rule out infection
Serially bloody BAL is indicative of diffuse alveolar hemorrhage
TBB: rarely useful in making the diagnosis of pulmonary vasculitis
Upper Airway Fiberoptic Exam with Biopsy of Suspicious Lesions
Especially useful in the diagnosis of Wegener’s Granulomatosis
OLB
Usually necessary to make the diagnosis
Renal Biopsy
Diagnostic features of granulomatous inflammation or vasculitis are rarely found, but the presence of focal, segmental necrotizing glomeronephritis without immune deposits (ie: pauci-immune) is strongly suggestive of a systemic vasculitis syndrome
Clinical Presentations Suggestive of Pulmonary Vasculitis