Evidences of healed tuberculosis are found in practically all
adult lungs in the form of localized thickenings or puckering
of the pleura, especially at the apices, hyaline or anthracotic
nodules, encapsulated, caseous or calcified tubercles. Old scars
and indurations are firm, hard and usually black in color. Caseous
areas are smooth, dry, white or grayish, and opaque. Very young
tubercles are elevated, grayish and translucent. Atelectatic areas
are depressed and bluish-red in color. Areas of hepatization are red
or gray, elevated, granular, crumbling, moist in early stage, dry in
caseous hepatization. In bronchopneumonia the areas of hepatization
are usually sharply circumscribed. Metastatic abscesses lie usually
beneath the pleura, are usually multiple and distributed over both
lungs. Bronchopneumonic areas are usually found in the dependent
portions, particularly in right lung. An abundance of foamy, watery
fluid on the cut-surface indicates œdema; when very bloody there
is usually a marked stasis or beginning hepatization present. In
atelectasis and fibrinous hepatization the exudate from the surface
is not foamy. Emphysematous areas are white or grayish-white and
are most frequently found along the borders. Large air-spaces are
often found along the interlobular septa (interstitial emphysema),
particularly in children following trauma, croup, whooping-cough,
etc. In chronic passive congestion the lung is firmer than normal,
deep-red or brownish in color. Hemorrhagic infarcts lie usually
beneath the pleura, are wedge-shaped, with base toward pleura, firm,
smooth on section, or granular, and when fresh are nearly black;
older ones are lighter and brownish. Cavities in the lung occur in
tuberculosis, embolic and primary abscesses, actinomycosis, gangrene,
bronchiectasis, primary and secondary tumors, etc. Gangrenous
areas have diffuse borders, are gray or greenish in color, with
central softened areas, with ragged borders and stinking smell. In
bronchiectatic cavities the smooth mucosa of the bronchus passes
directly into the wall of the cavity. Primary carcinomata of the
lungs appear as cavities having a white medullary wall, or as
medullary strands running along the bronchi. Tuberculous cavities
have caseous walls, are more or less encapsulated, and usually
show younger tubercles in the neighborhood of the wall. Antemortem
hypostasis is usually darker and firmer than postmortem, and is
usually associated with inflammation (hypostatic pneumonia).
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