LUNG - Wegener's granulomatosis

The specimen displays a portion of both lobes of the left lung, showing a fibrinous pleurisy. The cut surface shows a number of nodular areas, most marked at the periphery of the lung, but present also within its substance.
There is a small area of apparent caseation at the apex. The main bronchi are reddened but, to the naked eye, there is no obvious ulceration.
A 66-year-old-man, admitted in August 1976, with a history of 3 weeks of arthralgia, cough with mucoid sputum (1 week) and malaise and weakness (3 weeks). On examination, his liver was palpable, and there was a pleural effusion at the right base. An X-ray showed consolidation, with an alveolar distribution, and he developed haemoptysis. He became increasingly anaemic (8 g.) and was in respiratory failure. Red cell casts and haemoglobin were found in the urine, and a renal biopsy showed polyarteritis, or Wegner's granulomatosis.