(1978). Thorax, 33,[493][494][495][496][497][498][499] Pulmonary and systemic aneurysms in a case of widespread arteritis. A patient in whom asthma preceded the development of multiple pulmonary and systemic artery aneurisms died after dissection of the aorta. At necropsy he was found to have widespread arteritis of unknown aetiology affecting many large and medium-sized pulmonary and systemic vessels as well as a few microscopic ones. Endarteritis obliterans was present in some of the vasa vasorum. The clinical and histopathological findings are discussed in relationship to other known causes of arteritis, and it is concluded that this condition has not previously been described.Pulmonary artery aneurysms are conventionally divided into two groups. Those occurring in the large extrapulmonary vessels are most commonly associated with congenital cardiac abnormalities (Boyd and McGavack, 1939;Deterling and Clagett, 1947), while those occurring in the smaller intrapulmonary divisions are usually mycotic (Charlton and DuPlessis, 1961). All pulmonary artery aneurysms are extremely rare, and it is even less common to find pulmonary and systemic arterial aneurysms in the same patient. We report a case in which this occurred, secondary to widespread arteritis, and in which the pulmonary component raised diagnostic problems.
Case reportThe patient, a white engineer, developed asthma in 1970 at the age of 50. He was admitted to hospital three times with severe attacks of asthma during that year. On each occasion he responded well to corticosteroid treatment, and he was treated with intermittent courses of prednisone and with bronchodilators as an outpatient between these episodes. Typical asthmatic stigmata were present in the sputum (Sanerkin and Evans, 1965), but there was never a peripheral blood eosinophilia. Skin tests to common allergens and precipitins to Aspergillus fumigatus were negative. The ESR (Westergren) was always less than 12 mm ' in the first hour, and chest radiographs were normal. During the next four years the patient was admitted to hospital only twice, though by 1973 he needed continuous prednisone treatment.In March 1975 he was admitted to hospital with a three-week history of vertigo, recurrent vomiting, and intermittent loss of vision in the left eye. On questioning he described symptoms suggestive of Raynaud's phenomenon in his right hand, angina pectoris, and intermittent claudication, which had all developed over the previous two months. Physical examination showed bilateral femoral artery bruits, a bruit over the left subclavian artery, and a right subclavian aneurysm. At this time his ESR was 66 mm in the first hour, ANF was negative, but the DAT for rheumatoid factor was positive to a titre of 1/128. He had a peripheral blood eosinophil count of 790X108/1, the first time this had been raised since he developed asthma. His brain-stem symptoms were thought to be due to a subclavian-steal syndrome, associated with a systemic arteritis, but within a week all his symptoms disappeared without sp...