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
Bronchiectasis usually affects the small bronchi with no cartilage. It
is not uncommon to find greatly dilated bronchi with no cartilage in
close proximity to cartilage containing bronchi of smaller caliber. In
one instance (Autopsy 421) a bronchus of medium size with cartilage
measured 3 mm. in diameter, whereas two bronchi with no cartilage were
dilated to 4 and 6 mm., respectively. Nevertheless, larger bronchi are
occasionally the site of superficial loss of epithelium, necrosis
extending into the bronchial wall, formation of fissures and stretching
of the wall at the spot which is weakened. In association with these
changes atrophy of the cartilage may occur (Autopsies 421, 425, 440,
463). Plates of cartilage in process of atrophy are readily recognized
by their irregularly indented outline and often by their small size. The
fibrous tissue surrounding the cartilage is the site of chronic
inflammation and is densely infiltrated with lymphoid and plasma cells
among which polynuclear leucocytes are scant. Nevertheless, polynuclear
leucocytes are abundant in immediate contact with the cartilage and
appear to have an important part in the solution of its matrix, for
about them occur indentations of the edge. Leucocytes penetrate into the
cartilage.
The necrosis and tears which occur in the wall of the bronchus are not
always limited to the bronchus, but may extend deeply into the
surrounding tissue. In Autopsies 312 (Fig. 21) and 423 wide areas of
necrosis have penetrated deeply into the tissue about the bronchi.
=Autopsy 312.=—Illness began with influenza on September 26,
seventeen days before death; a diagnosis of lobar pneumonia with
consolidation of the right lower lobe was made ten days after onset
and Pneumococcus IV, B. influenzæ and S. hemolyticus were found in
the sputum. At autopsy there was bronchopneumonia with red and gray
lobular and confluent lobular patches of consolidation and right and
left serofibrinous pleurisy; there was purulent bronchitis; no
abscesses were seen. Small bronchi throughout both lungs were
dilated and often surrounded by a zone of hemorrhage.
Hemolytic streptococci were found in the heart’s blood, in the
pleural exudate, consolidated lung and bronchus; B. influenzæ was
found in the lung and in a small bronchus, and staphylococci in the
contents of a small bronchus.
[Illustration:
Fig. 24.—Acute bronchiectasis with fissures extending through
bronchial wall which is marked by great engorgement of blood
vessels; at one point a fissure has penetrated deep into the
alveolar tissue and formed a small cavity containing purulent
exudate and surrounded by fibrinous pneumonia. Autopsy 312.
]
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