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
The right pleural cavity contains 85 c.c. of thick purulent fluid; the
right lung (Fig. 9) is collapsed and pushed to the median line, being
bound by firm adhesions to the pericardium. Over the external and basal
surfaces is a localized cavity walled off by adhesions. An abscess
cavity in the lower part of the lower lobe communicates through a
perforation in the basal surface of the lung with the pleural cavity and
is in free communication with a small bronchus. About the abscess the
lung is red and laxly consolidated, but elsewhere air containing;
throughout the lower half of the lower lobe, the interlobular septa are
marked by conspicuous yellowish gray lines about 1 mm. in thickness.
Between these thickened septa the lung tissue contains air. The lung
weighs 600 grams. The left lung (Fig. 10) is voluminous and heavy,
weighing 1,320 grams. The surface is everywhere covered by thickened
pleura and fibrin, the pleural cavity containing 150 c.c. of thick
purulent fluid. The lung is consolidated varying in color from a fleshy
red to yellowish gray. The surface is very conspicuously marked by
yellow lines 2 or 3 mm. thick, corresponding to the interlobular septa
which have undergone suppuration. The septa have bead-like swellings
along their course, and when pus escapes from the cut surface small
cavities remain at the site of these swellings.
Bacteriologic examination has shown hemolytic streptococci in the blood,
left lung, right and left pleural cavities, and right bronchus. B.
influenzæ has been found in the bronchus, in the right pleura and in the
heart’s blood. A few colonies of S. aureus have been found on the plate
from the right pleural cavity (site of thoracotomy).
Microscopic examination of the right lower lobe shows that the
interstitial septa are much thickened by young fibrous tissue
infiltrated with lymphoid and a few plasma cells. Large mononuclear
cells with granular cytoplasm are very numerous. A lymphatic is much
distended and contains a few polynuclear leucocytes and many lymphoid
and large mononuclear cells. There is no suppuration. Sections from the
right lung show suppurative lymphangitis with suppurative inflammation
of interstitial tissue.
The right lung is the site of a healing lesion of the interstitial
tissue which has developed simultaneously with acute interstitial
suppurative pneumonia in the left lung. Both lesions are doubtless
caused by S. hemolyticus. This healing lesion exhibits little similarity
to the interstitial bronchopneumonia described by several observers with
both measles and influenza.
The following autopsy furnishes further evidence that interstitial
suppurative pneumonia exhibits a tendency to heal. Proliferation of
endothelial cells lining the inflamed lymphatics gives rise to
phagocytic cells which aid in removing the accumulated leucocytes.
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