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
Microscopic examination shows that the epithelium of dilated bronchi
has disappeared and the denuded surface is covered by fibrin and
polynuclear leucocytes; fissures extend from the lumen through the
bronchial wall into the surrounding alveolar tissue. A zone of
fibrinous pneumonia surrounds these bronchi and fissures in the
bronchial wall penetrate into this zone. One dilated bronchus 2.4
mm. in diameter with no cartilage in its wall has vascular
connective tissue covered by epithelium on one side, whereas the
remainder of the circumference is formed by exposed alveoli filled
with fibrin, the bronchial wall having disappeared. A section
through a part of the abscess which has been mentioned shows a very
irregularly formed cavity approximately 1 x 0.7 cm. Remains of
bronchial wall, consisting of very vascular tissue covered by flat
epithelium in several layers, indicate the origin of the cavity.
Between these remnants of bronchi deep pockets extend into the
pulmonary tissue which in the margin of the cavity is the site of
fibrinous pneumonia. In one place, in contact with the cavity, a
wide area of consolidated tissue has undergone necrosis and both
alveolar walls and their contents have lost their nuclei. Leucocytes
which are accumulating at the margin of the necrotic patch form a
line of demarcation between living and dead tissue.
Abscess may be the result of the profound changes which occur in the
bronchi as the result of influenza. Necrosis caused by bacteria within
the bronchi weakens and in places destroys the wall. Bacteria penetrate
into the surrounding tissue and hemolytic streptococci (or
staphylococci) may produce localized abscesses. These abscesses are
usually situated near the pleural surface of the lung, because
destructive changes causing rupture of the bronchial wall occur more
frequently in the smaller peripheral bronchi than in the larger bronchi
containing cartilage. Abscesses occur more frequently at the bases of
the lungs, because the most severe changes in the bronchi occur in the
dependent part. (See “Bronchiectasis,” p. 240.)
=Healing of Abscess.=—The following autopsy is of interest in relation
to the treatment of pulmonary abscess and associated empyema.
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