Adenocarcinoma of the Bronchus, with Widespread Metastases

Abstract

Mrs. J. G. W., white female, housewife, aged 49, was admitted to the Wisconsin General Hospital on February 20, 1931, complaining of pain and swelling in the left leg. She stated that on October 29, 1930, she had sustained an injury to the fingers of her left hand and to the left lower leg in an automobile accident. A superficial laceration from scraping of the skin marked the place of injury to the left leg, which might have escaped attention had it not been for the adherence of the stocking to the abraded area by reason of exuded serum. Varicose veins had been noticed in both legs since the last pregnancy, 11 years before, and these varicosities had been more marked on the left lower leg. The morning following the injury the left leg was quite painful, but she was able to walk. There was no swelling at this time, but the second day after the injury the patient was unable to walk by reason of the pain and swelling in the left lower leg. There were also a number of circular red spots on the left lower leg about three inches in diameter, which felt like burns and were painful to the touch. Since that time, the patient had remained in bed, experiencing irregular exacerbations and remissions of the local condition. The history by systems was interesting in two details, namely, a cough, usually non-productive since the time of injury and particularly marked when lying on the left side, and constipation. The patient had had hemorrhoids over a period of three years and there had been bleeding up to the time of admission. The past medical history was important because of the details of typhoid fever at 15 years of age and pleurisy at 19 years of age. A hemorrhoidectomy had been performed four years before and a herniotomy twenty years before. Her social history was without bearing on the present conditions, as was the family history, except for the occurrence of epithelioma in the paternal grandfather. Physical examination revealed the following pertinent findings: pigmented nevi on the right cheek and beneath the left angle of the jaw; small, firm cervical lymph nodes about the left clavicle; retraction of the left chest close to the sternum in the first and second interspaces, over which area there was decreased tactile fremitus and dullness to percussion, the area of dullness extending 5 cm. from the left border of the sternum in the first interspace, whereas posteriorly the dullness was noted off the spine of the left scapula toward the vertebral column. The breath sounds were bronchial to amphoric over the area of dullness, with marked increase in the spoken voice and definite whispering pectoriloquy. The entire remaining left chest showed a decreased resonance, the breath sounds were somewhat suppressed, and there were abundant medium and fine moist rales throughout the left, with a few fine crepitant rales at the right base. The heart was widened in the transverse diameter, measuring 16 cm. at the maximum width.