Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measlesOpie, Eugene L. (Eugene Lindsay)
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Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measles
The histology of consolidation which is definitely limited to secondary
lobules or groups of lobules varies considerably. When death occurs in
the early stage of the lesion, consolidated patches are deep red and
somewhat edematous, so that bloody serous fluid escapes from the cut
surface of the lung and red blood corpuscles are present in the alveoli
in great abundance together with polynuclear leucocytes, fibrin and
serum in varying quantity. It is not uncommon to find evidence that the
lesion has had its origin in the bronchioles and extended from them to
other parts of the lobule. Polynuclear leucocytes may be relatively
abundant within and immediately about the bronchioles and alveolar
ducts, whereas the intervening alveoli and infundibula are filled with
red blood corpuscles among which are polynuclear leucocytes and perhaps
some fibrin. It may be evident that bronchiolar pneumonia with
hemorrhage into intervening alveoli is in process of transformation into
a more diffuse leucocytic pneumonia, for polynuclear leucocytes are
making their way from the alveolar wall into the blood-filled lumen and,
as the result of the presence of blood, remain for a time close to the
lining of the alveolus.
When the consolidated lobules have assumed a gray or reddish gray color,
polynuclear leucocytes are more abundant and often almost homogeneously
pack every alveolus within the boundaries of the lobule. In some
instances there is fibrin partially obscured by the presence of
leucocytes in great number.
Although fibrin is less abundant with bronchopneumonia than with lobar
pneumonia, nevertheless in a considerable proportion of instances it is
a very conspicuous element of the inflammatory exudate within the
bronchioles, alveolar ducts and alveoli. It is unusual to find the
alveolar ducts and alveoli uniformly plugged with fibrin containing
leucocytes; there is a variegated distribution of exudate which has
little resemblance to that of lobar pneumonia. Occasionally (Autopsies
242 and 247) polynuclear leucocytes fill the bronchioles, alveolar ducts
and infundibula, whereas the surrounding tributary alveoli contain
fibrin and polynuclear leucocytes in moderate number; red blood
corpuscles may be present in sufficient number to give a homogeneously
red color to the lobular consolidation.
In association with lobular pneumonia, fibrin within the lung tissue
undergoes certain changes which outline very sharply the alveolar ducts
and the other structures usually ill defined in preparations of the
lung. A remarkable appearance is produced by the deposit of hyalin
fibrin upon the surface of the alveolar ducts and infundibula. This
lesion has been described by LeCount.
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