Bronchocentric injury in Wegener's granulomatosis: a report of five cases.

While Wegener's granulomatosis is recognized primarily for its vascular destruction, the extravascular granuloma is an integral part of the inflammatory process. We report five illustrative cases of this phenomenon in which the necrotizing process appeared to be centered primarily on the airways. This was associated with multisystem disease and cavitary lung nodules, which probably resulted from extensive airway necrosis. Prognosis with conventional cytoxan and prednisone therapy was excellent. The differential diagnosis of bronchocentric Wegener's granulomatosis with bronchocentric granulomatosis, infection, and aspiration pneumonia is discussed.