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
In 6 instances there has been frank pneumonic consolidation limited to a
zone encircling small and medium-sized bronchi which have often been
obviously dilated. On cross section these patches of pneumonia are
circular, from 1 to 2 cm. in diameter and each contains a bronchus at
its center. When the bronchus is cut longitudinally it is evident that
pneumonic consolidation forms a cylindrical sheath about the tube. The
consolidation varies in color from red to grayish red. In one instance
(Autopsy 253) the consolidated tissue has formed a gray zone in contact
with the bronchus and is red in a peripheral zone; microscopic
examination shows that the alveoli about the bronchus contain fibrin,
whereas those at a greater distance contain red blood corpuscles. In
this instance, the associated pneumonia in another part of the lung has
been somewhat anomalous and has had characters both of lobar and
bronchopneumonia, for scattered in the left lung there have been patches
of firm consolidation not more than 2 cm. across. The smaller of these
patches are deep red, but the larger are coarsely granular and gray in
the center. The patchy character of the lesion has suggested
bronchopneumonia, but the coarse granulation on section and the presence
of fibrinous plugs within the small bronchi have presented a close
resemblance to lobar pneumonia. This autopsy is one of the few instances
in which Pneumococcus II has been found, Pneumococcus II being present
in blood and lungs, B. influenzæ, in lungs and bronchi. In 2 additional
instances (Autopsies 374 and 392) peribronchial pneumonia, recognizable
at autopsy, has been associated with consolidation having the characters
of lobar pneumonia. In one instance, Autopsy 374, the right lung has
contained two patches of firm, mottled red and pinkish red coarsely
granular consolidation each about 6 cm. across, one situated in the
upper lobe and the other in the lower lobe. Elsewhere in the lung, in
definite relation to dilated bronchi, occur patches of firm, red,
coarsely granular consolidation from 1 to 1.5 cm. in diameter when cut
transversely. The bronchus in the center has contained purulent fluid.
In the opposite lung similar consolidation has been limited to zones
about dilated bronchi which contain purulent fluid. Pneumococcus IV has
been obtained from the blood of the heart.
The peribronchial pneumonia which has been described occurs in
association with evidence of profound injury to the bronchial wall. In 5
of 6 instances purulent bronchitis has been found at autopsy; in half of
these instances bronchiectasis has been noted. The epithelium of the
bronchus has been found separated from the underlying tissue by serous
exudate, blood and leucocytes; epithelial cells undergo necrosis and
disappear, the denuded surface being covered by fibrin. Necrosis extends
a varying depth into the wall of the bronchus; blood vessels are
engorged, and there is in some instances hemorrhage throughout the wall
of the bronchus.
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