A Case of Capillary Hemangioma of Lingular Segmental Bronchus in Adult
A 61-year-old man visited to outpatient clinic due to small amount of fresh blood in sputum lasting for a week. He had been treated with asthma and emphysema with inhaled long-acting anticholinergics (Spiriva; Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA), inhaled corticosteroids (Alvesco; Nycomed GmbH, Milford, MA, USA) and oral theophylline from a year ago in our clinic. He was treated with pulmonary tuberculosis about 30 years ago and had tuberculosis sequelae in right upper lobe. He had smoked 30 pack-year of cigarettes and quit smoking 10 years ago. He had history of hypertension and diabetes mellitus, but has taken neither anti-platelet agent nor anticoagulant.\nOn physical examination, blood pressure was 140/80 mm Hg, heart rate was 88 beats/min, respiratory rate was 20 breaths/min, and body temperature was 36.1℃. The findings of auscultation were not significant. Laboratory tests revealed normal values of complete blood cell count, electrolytes, chemistry profile, arterial blood gas analysis, erythrocyte sedimentation rate, and C-reactive protein concentration.\nSimple chest radiograph showed irregular nodular and linear opacities with volume loss in right upper lobe, which was compatible with inactive pulmonary tuberculosis. The opacities have not been changed in comparison with chest radiograph examined two-months ago. Chest computed tomography showed centrilobular and paraseptal airspace enlargement in both lungs and irregular linear and nodular opacities with distortion of surrounding architecture in right upper lobe. A tiny enhancing nodule was seen at bronchial wall of lingular segment of left upper lobe ().\nFlexible bronchoscopy was performed under local anesthesia and a 3 mm sized polypoid lesion with pinkish color was found on the medial side of left lingular segmental bronchus (). Forcep biopsy was performed to examine and remove the lesion and small amount of bleeding was followed. The amount of bleeding was minimal and the bleeding stopped after endobronchial instillation of 1:10,000 diluted epinephrine. Small amounts of hemoptysis appeared one time after bronchoscopy, then no more hemoptysis was found till 4 weeks after bronchoscopy.\nLight microscopic findings revealed small polypoid nodule which showed proliferation of blood vessels of capillary caliber and surface bronchial epithelium. The bronchial epithelium was partly eroded. Immunohistochemical stain for CD31 demonstrated vascular endothelial cells ().