The pathology of influenzaWinternitz, M. C. (Milton C.)
Science
The pathology of influenza
Winternitz, M. C. (Milton C.)
Influenza
The lung remains increased in volume and its surface is mottled with
vivid colors. Often these are an indication of deeper parenchymatous
change. The pale pink zones, through the pleural surface of which
distended alveoli are discernible, are still prominent in the upper
lobe, around the margins, and on the anterior surface of the lung. The
darker purple, slightly elevated, often circumscribed, infarct-like
areas (25, 34, 108) may occur anywhere, but are more frequent in the
lower lobes. Small, maroon, slightly depressed areas of atelectasis may
also involve the borders of the lung, usually the posterior borders; or
they may occur between larger and more elevated areas on either lobe.
Besides the purple, firm, projecting foci, paler pink or grey nodules of
similar consistence may be present and show no structure when viewed
through the pleura. The distribution of the different types of change is
variable, and, aside from the fact that they involve the middle and
lower lobes more frequently than the upper, no general statement is
possible. In a few instances, one lobe, almost always the lower, may be
more voluminous than the others, and although its pleura often suggests
lobular involvement, the masses tend to be confluent and suggest a
pseudolobar change. Sometimes, though rarely, this approaches a true
lobar type of consolidation. (Compare Figs. XIII and XXVII.)
Occasionally, the changes in the lung, except its increase in size, are
obscured by pleural exudate which may form a thick, buttery, rather
sticky mass on the surface (12, 19, 157) (Fig. XXXVII). Such pleural
exudates are rare, and likewise it is uncommon to find so little pleural
granulation as in the previous group. The roughening, as a rule, is not
uniform, but is more prominent over the lower lobes and in the
interlobar spaces than elsewhere. It may occur when there is no definite
increase in the fluid content of the pleural sac.
The lung, now sectioned, presents a surface in accord with the changes
suggested from the description of its external appearance. As compared
with the first stage the amount of syrupy, blood-stained exudate may be
definitely decreased, especially in the upper lobe or in those portions
of the lung where the solidification is less marked. Its character, too,
may be more cloudy, and more ropy, or viscid; it bathes the surface and
is scraped off in abundance with the blade of a knife from the
underlying consolidated foci (108, 156). The bronchi and bronchioles,
however, may be prominent, irrespective of the change in the parenchyma
itself. From their lumina, thick, yellow pus wells forth and their
mucous membrane is intensely congested. Where such involvement occurs in
unconsolidated portions of the lung, the bronchioles are even more
striking than in the hepatized areas in which the more widespread
changes obscure the process. The dilatation of the bronchioles,
especially in their smaller ramifications, is still conspicuous.
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