Cavernous Hemangioma of the Lung: Secondary Polycythemia

Hemangioma of the lung is a rare disease. If the lesion is a large one, the arterio-venous fistula which it in effect produces, may be sufficient to cause a secondary polycythemia. Up to the writing of this paper, there were two case reports of hemangioma of the lung with secondary polycythemia. Recently a third report has been added, and for the first time, a pneumonectomy was done for the tumor, with complete disappearance of the polycythemia and the accompanying symptoms. This report is based on a case of a twenty-two year old male with a cavernous angioma causing a severe secondary polycythemia. A roentgenogram of the chest at the age of five was available showing the lung lesion present at that time. The symptoms, physical signs and course of the disease in all the reports are so similar that a clinical entity of cavernous hemangioma of the lung with secondary polycythemia can be established. In 1938, Rodes1 reported the first case of hemangioma of the lung complicated by secondary polycythemia. The patient, a twenty-five year old male, gave a history of cyanosis and dyspnea since childhood with clubbing of the fingers at the age of fifteen. His red blood cell count was 7,540,000, hemoglobin 118 per cent. A roentgenogram of the lungs showed three spherical shadows in both lower lung fields. The patient died of pulmonary hemorrhage and at postmortem there were found three hemangiomata of the lungs, two in the right side, one in the left. The diagnosis was not made antemortem. Horton and Smith2 in 1939 reported the second case. Their patient, a forty-seven year old male, gave a history of being a "blue" baby at birth. Clubbing of the fingers and cyanosis were noted at the age of twenty-four. He was first examined by Horton and Smith in 1932 when he showed cyanosis, marked clubbing of the extremities, a red blood cell count of 6,000,000 and hemoglobin of 20.6 grams. He was thought to have polycythemia vera. He was seen again in 1938, when his red blood cell count was 6,740,000, hemoglobin 23.7 grams, blood volume 121 cc. per kilogram. A bruit was heard in the base of his right lung, not heard in 1932. A roentgenogram of the chest showed an infiltration of the right postero-lateral lung field. Injection of a