[Pulmonary granulomatous lesion with severe chest pain and hemoptysis: a case report].

We encountered a rare case of pulmonary granulomatous lesion accompanied with severe chest pain and hemoptysis. A 42-year-old man visited our hospital complaining of hemosputum. A chest radiograph showed a nodular shadow in the left lower lung field. Further examinations including fiberoptic bronchoscopy, bronchoalveolar lavage and transbronchial lung biopsy did not suggest a diagnosis. During the course of his illness, he suffered an episode of severe chest pain which could be controlled only by intravenous morphine chloride (10 mg). The chest radiograph at the time showed a broad infiltration in the left lower lung field. However, the lung perfusion scintigram taken 2 days before demonstrated decreased blood flow in the same field. We waited for the infiltration in the chest radiograph to diminish and then performed partial resection of the left lower lobe, thus terminating both hemosputum and chest pain. Histological examination showed a cavitary lesion in the periphery of the lung, surrounded by large numbers of infiltrating plasma cells and lymphocytes, among which were many hemosiderinladen macrophages. A small amount of mycelium, considered to be Nocardia or fungus, was seen in the cavity wall. These findings may indicate that an infection had contributed to the formation of a hemorrhagic granulomatous lesion, and that this lesion caused chest pain mainly because of the pleuritis and the decrease in the local pulmonary circulation.