Some common errors in diagnosis and treatment of chest problems

Abstract

The above discussion of chest problems and the illustrative case reports are an index to the frequency with which physicians not especially interested in this field are contributing to mortality and morbidity by their failure to pursue proper diagnostic and therapeutic procedures. These errors are made not only by men who neglect altogether to read medical journals, but frequently by otherwise generally efficient physicians and surgeons as well. Some of the most common errors in diagnostic and therapeutic procedures which are made by the general profession are as follows: 1. 1. Failure to request bronchoscopic examinations in doubtful cases such as those discussed above. Lack of appreciation of the pathology, physiology, and varying etiology of atelectasis and lung abscess seems in particular to be noteworthy, the term “unresolved pneumonia” being used altogether too frequently. 2. 2. Failure to consider the various potential etiologic factors in empyema, thereby allowing diagnostic curiosity to be too frequently satisfied with an x-ray report of empyema is common. It is necessary to realize that lung abscesses from various causes, including lung carcinomata and aspirated foreign bodies, may have been present previous to the empyema. 3. 3. Failure to determine whether or not multiple encapsulations are present in neglected cases of empyema and to treat these pockets by open thoracotomy with breaking of the septa instead of simple insertion of a single drainage tube with consequent drainage of only one pocket. 4. 4. The still too frequent tendency to classify all chronic coughs and accompanying symptoms as tubercular; and allowing individuals to go for weeks or months “awaiting developments” when early pursuit of procedures, such as lipiodol injections and bronchoscopy, might be life-saving, particularly in early bronchogenie carcinoma. 5. 5. Failure to appreciate that thoracic surgeons now have ample statistics proving that pneumonectomy, lobectomy, pneumonotomy and thoracoplastic procedures judiciously used are tremendously valuable in otherwise hopeless chest conditions including, in addition to those disorders mentioned above, far advanced bilateral cavernous pulmonary tuberculosis.