Cavernous pulmonary telangiectasis.

A cavernous pulmonary telangiectasis is a wide peripheral communication between a dilated, tortuous, thin-walled pulmonary artery and the corresponding pulmonary veins. It is part of a more or less generalized condition of telangiectasia in which small telangiectases are scattered in variable distribution and numbers in the lungs and elsewhere in the body. The striking appearance and obvious clinical effects of the large pulmonary lesion have blinded observers to its relationship to the generalized telangiectasia. The first report of this unusual condition was made by Bowers (1936), who found multiple " haemangiomatous " masses in the lungs of a baby boy who had died two days after birth from haemorrhage into the pleural cavity. The second case, also diagnosed at necropsy and reported by Rodes (1938), was that of a man aged 25 who had died of haemoptysis. There were multiple "haemangiomata" in the right lower and middle lobes and in the left upper lobe. In this case the chief clinical features, namely, dyspnoea, cyanosis, clubbing of the fingers, and polycythaemia, were described for the first time. In the following year Smith and Horton (1939) recorded the first successful diagnosis of the condition during life, and named it "arteriovenous fistula of the lung." Since then it has been called cavernous haemangioma or arteriovenous fistula. The next advance came when Shenstone (1942) described his successful removal of the lesion by pneumonectomy in 1940. The patient was a woman aged 23 whose signs and symptoms have been recorded by Hepburn and Dauphinee (1942). These authors directed attention to the fact that symptoms such as tinnitus, faintness, and thick speech which were seen in this case were attributable to the polycythaemia rather than directly to the abnormal anastomosis, and they noted the disappearance of the polycythaemia after the removal of the lesion. A further step was the successful local excision of two haemangiomata from the right lung, followed at a second stage by resection of one from