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
Several observations help to explain the occurrence of abscess in
association with the pneumonia of influenza. The fissures which will be
described in association with bronchiectasis represent traumatic
ruptures of the bronchial wall consequent upon weakening by necrosis and
over distention. They expose the injured bronchial wall and the alveolar
tissue adjacent to it to infection by the microorganisms contained
within the lumen of the inflamed bronchus. Occasionally a favorable
microscopic section demonstrates the relation of pulmonary necrosis and
consequent suppuration to injuries of the bronchial wall. Peribronchial
fibrinous pneumonia occurs about the bronchi of which the epithelial
lining has been destroyed, and when a fissure penetrates the bronchial
wall fibrinous pneumonia is almost invariably found in a zone about the
tear; it doubtless tends to limit the extension of the process.
Occasionally, wide areas of necrosis occur within consolidated tissue
near the site of the fissure (Autopsy 312 with S. hemolyticus and B.
influenzæ, p. 254). Accumulation of polynuclear leucocytes between
living and dead tissue may form a line of demarcation (Autopsy 387);
finally, fairly large, irregularly formed, abscess cavities are found.
Necrosis and beginning suppuration in contact with the lumen of the
bronchus will be described in association with bronchiectasis (Autopsies
312, Fig. 24, and 423, p. 256). In the following autopsies upon
individuals who have died with pulmonary abscesses, favorable
microscopic sections have demonstrated abscess formation in contact with
lesions which have penetrated the walls of small bronchi. They help to
explain the pathogenesis of abscess in association with influenza.
=Autopsy 376.=—H. M., white, aged twenty-four, a fireman, resident
of Oklahoma, had been in military service one month. Onset of
illness occurred October 1, ten days before his death; he was
admitted to the base hospital on the fourth day of his illness with
the diagnosis of bronchopneumonia.
=Anatomic Diagnosis.=—Acute bronchopneumonia with patches of lobular
and confluent lobular consolidation in both lungs and hemorrhagic
peribronchiolar consolidation in right upper lobe; abscess in right
upper lobe below pleura; fibrinopurulent pleurisy on right side;
purulent bronchitis; bronchiectasis at base of left lobe.
An irregular abscess, 2 x 1 cm., filled with creamy purulent fluid
is separated from the interlobular surface of the right upper lobe
by a thin membrane representing the pleura. The right pleural cavity
contains 200 c.c. of turbid yellow fluid in which is soft fibrin.
The bronchi contain purulent fluid in great abundance. The bronchi
at the base of the left lower lobe are widely dilated, so that many
small bronchi with no cartilage in their wall measure from 3 to 5
mm. in diameter.
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