Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measlesOpie, Eugene L. (Eugene Lindsay)
History
Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measles
Within the alveolar tissue of the lung, spaces are seen lined by a layer
of fibrin which stains homogeneously and very brightly with eosin. They
are recognized as alveolar ducts by the presence of scattered bundles of
smooth muscle in their wall. The layer of hyaline fibrin overlying the
surface of the alveolar duct usually forms a continuous lining and
covers over the orifices of the alveoli which surround the alveolar
duct. These ducts are rendered still more conspicuous by the character
of their contents which exhibits a sharp contrast with that of the
surrounding alveoli. The alveoli duct occasionally contains a bubble of
air, but more frequently it is filled with serum in which red blood
corpuscles are sometimes numerous. There is within the lumen scant
fibrin and very few cells, among which polynuclear leucocytes are
predominant. In the surrounding alveoli on the contrary leucocytes and
fibrin are abundant. A similar change is found in the infundibula very
clearly defined by their conical form, which is especially well outlined
below the pleura or in contact with interlobular septa. The infundibulum
is outlined by hyaline fibrin which passes over the orifices of the
tributary alveoli and separates the serous contents of the infundibulum
from the cellular fibrinous contents of the alveoli about.
The lesion which has been described is often associated with acute
bronchitis and bronchiolitis, and the alveoli immediately about the
respiratory bronchioles may be filled with polynuclear leucocytes. It is
very common to find large bubbles of air sharply defined within the
purulent contents of the bronchiole. In some lobules the alveolar ducts,
infundibula and alveoli intervening between these foci of leucocytic
pneumonia are almost uniformly filled with fibrin and polynuclear
leucocytes, but in other places the formation of complete layers of
hyaline fibrin is in process. Bubbles of air are often seen within the
alveolar ducts, and about them is an irregular layer of fibrin formed by
the penetration of air into a channel previously filled with a loose
network of fibrin containing serum in its meshes. The fibrin compressed
against the walls of alveolar duct and infundibulum remains as a compact
layer separating these structures from the alveoli which project from
their walls. The bubble of air is doubtless later absorbed and replaced
by serum, so that many alveolar ducts are filled with serum almost
wholly free from cells, whereas alveoli outside the fibrinous membrane
contain a network of fibrin with leucocytes in greater or less
abundance.
In association with this fibrinous pneumonia, which has been described,
hyaline thrombosis of the capillaries is not uncommon. This hyalin
material within the capillaries gives reactions of fibrin, and in
sections stained by the Gram-Weigert method for demonstration of fibrin,
these thrombosed vessels have the appearance of capillaries irregularly
injected with a blue material.
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