Chest Signs Research Articles

Desquamative interstitial pneumonia

The clinical, radiological and pathological features of desquamative interstitial pneumonia in a 55-year old Jamaican male negro are described. Although the patient presented with progressive effort dyspnœa there were minimal abnormal chest signs but marked derangement of the respiratory function tests. The most severe radiological changes were demonstrated in the middle zones of the lung fields, and a follow-up chest film 2 months later showed slight involvement of the lower zones as well. The microscopic appearance was typical of the condition except that the vascular changes overshadowed the other abnormalities present. Although there was an excellent subjective response to steroid therapy, lung function tests repeated 2 months after the onset of the disease showed no significant change.

Secondary Haemorrhage from the Ovarian Blood Vessels—A Case Report

Summary:1. Secondary haemorrhage from an ovarian blood vessel has been described after a difficult hysterectomy.2. Bleeding occurred upwards into the soft tissues of the loin and it was some days before external evidence of the haemorrhage was seen.3. Pressure on sympathetic nerve fibres produced a severe degree of paralytic ileus, although bowel sounds were increased.4. Chest signs were present because of elevation of the diaphragm on the affected side.5. It was important to differentiate this condition from a mechanical obstruction of the bowel and from a perforated hollow viscus in order to avoid unnecessary surgery.6. A considerable amount of air remained in the abdominal cavity for a week after laparotomy.

“ Q ” FEVER : CLINICAL FEATURES IN 72 CASES

SummaryIn 72 consecutive cases of “ Q ” fever, with no death, the commonest symptoms were headache and anorexia. Myalgia, sore eyes, cough, chills and sweats were also frequent. The commonest signs were a relative bradycardia, hepatomegaly and splenomegaly. Minor chest signs were frequently found. The total duration of fever was 10 days or less in the majority of cases. The longest duration of continuous fever was 24 days, and of intermittent fever 34 days.Common laboratory findings included an increased erythrocyte sedimentation rate, the presence of atypical mononuclear cells during the acute illness and an absolute lymphocytosis during convalescence. Only three patients had radiologically demonstrable pneumonic changes. However, respiratory infection of a lower severity was frequent, and this suggests that local strains of Coxiella burneti may be less virulent than overseas strains. Subclinical involvement of the liver was common, and in seven cases there was electrocardiographic evidence of transient myocardopathy.About 70% of patients returned to work within six weeks from the onset, but the convalescence of the remainder was protracted. The duration of convalescence was prolonged with increasing age. Infection with C. burneti may become chronic.Cases are described in which “ Q ” fever was complicated by pneumonia, pleural effusion, thrombocytopenia, encephalitis and endocarditis, and in which the problem of chronicity is illustrated.

Myasthenia gravis developing fifteen months after removal of thymoma.

A relationship between the thymus and myasthenia gravis has been accepted by a number of investigators.* However, the nature of this association is still unknown. Nevertheless, in patients with myasthenia gravis whose disease cannot be adequately controlled with medication, irradiation or removal of the thymus has been recommended.† The results of surgery have been variable, but it is generally agreed that they are better in those patients who have a simple hyperplasia of the thymus than in those with a thymic tumor. The appearance of myasthenia gravis after the removal of a thymoma is quite rare. A review of the literature has disclosed only four cases in which symptoms of myasthenia developed following excision of a thymoma. Fershtand and Shaw 14 reported the onset of myasthenia gravis in a 27-year-old man who had a three-week history of chest pain and signs of superior vena caval obstruction. A mass extending along

Acute tuberculous septicaemia

Three cases are reported of acute tuberculous septicaemia and their features are compared with those previously recorded in the literature. All cases have been fatal with the exception of a case reported by Paulley.8 A fourth case is described which is believed to be a case of tuberculous septicaemia which was treated with streptomycin, P.A.S. and I.N.H. with recovery. The features of this condition are pyrexia with leucopenia, usually abnormal chest signs, splenic enlargement, with jaundice or skin rashes.

Cavitary disease of the lungs; due to less frequent etiological factors.

A Cavity in the lung is defined as an abnormal hollow space within the pulmonary parenchyma. It may be positively identified roentgenographically when it communicates with a bronchus because, under such condition, it is likely at one time or another to contain air, with or without a fluid level. A tuberculous cavity, the most common variety, forms when a caseous focus liquefies and ruptures into a bronchus. Among other causes for cavitation are aspiration pneumonitis, septic emboli, non-septic emboli which become infected, mycotic disease, foreign bodies in the bronchi or lung parenchyma, benign and malignant neoplasms. Early recognition of the etiologic factor producing the cavity is of prime importance. It may be based on the roentgen appearance, frequency of prevailing diseases, and clinical course. Occasionally, however, difficulties may be encountered in early demonstration of the causative agent because of a paucity of differential diagnostic criteria, an aberrant clinical course, non-informative though well performed bronchoscopies, comparative rarity of the disease, or misleading gross appearance of tissues during a surgical procedure. The more unusual the etiologic factor, the less frequent will be an early etiologic diagnosis. Five cases will be recorded here with cavitation traceable to infrequent causes. Four of these presented difficult diagnostic problems. Report of Cases Case 1. A 26-year-old white male had a head cold and mild unproductive cough three weeks before admission to The Veterans Hospital. This was followed by blood-streaked sputum and a low-grade fever. Laboratory Findings: Chest films revealed infiltrations andcavitation in the antero-inferior segment of the right upper lobe (Fig. 1). Sputum was consistently negative for tubercle bacilli. Essential Clinical Findings: Physical examination was negative except for clubbing of the fingers. There were no chest signs. Clinical Course: The patient was admitted to the hospital Aug. 6, 1946, for the treatment of a lung abscess. Massive doses of penicillin and aerosol were administered. Operation for a non-putrid abscess was done Oct. 22, 1946. The involved lobe presented areas of softening surrounded by nodulations, with numerous succulent lymph nodes surrounding the trachea. Biopsy specimens were taken of lung tissue and a lymph node, and a diagnosis of Hodgkin's disease was established. The patient was given radiation therapy and nitrogen mustard. He ran the usual course of Hodgkin's disease, with remissions and exacerbations. Extensive osseous metastases later developed and death occurred June 24, 1948. Comment: The most usual cause for fever, cough, and blood-streaked sputum is pulmonary tuberculosis or lung abscess. The roentgen findings early in the course of this disease were not unlike those of tuberculosis. Failure to demonstrate tuberculous organisms, however, led the clinicians to suspect a non-putrid abscess, and surgery was undertaken.