Indurative mediastino-pericarditis / by Thomas Harris.

  • Harris, Thomas.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Indurative mediastino-pericarditis / by Thomas Harris. Source: Wellcome Collection.

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    lung consists of little more than deeply pigmeuted cicatricial tissue surrounded by a much thickened pleura, and having embedded in it large dilated bronchi which, towards the upper part, form distinct bronchiectatic cavities. The pleural involvement over this part of the lung has evidently been secondary to, or at least associated with the chronic fibrosis of the lungs and is not a primary condition. The lower portion of this left lung is more or less air containing, but in parts presents a certain amount of fibroid induration. No evidence of caseation or of recent tubei'cles. Weight of left lung, lib, lOoz. The right luug is very similar in general appearances to the left one, but is not quite so exten- sively affected. The upper part of the upper lobe is in a condition of fibroid induration with bronchiectatic cavities. Tn one or two places there is a very small focus of caseation. In the upper part of the lower lobe there is also slight fibrosis, whilst the greater part of this lobe is extremely congested and presents evidence of more recent tubercular involvement. Weight of right lung, 21bs. 2oz. Bronchi of both sides much congested, slightly thickened, and dilated into bronchiectatic cavities in the midst of the fibroid parts of the lungs. No bronchiectatic cavities in the lowermost parts of the lungs. Larynx and trachea congested, but otherwise presenting no abnormal appearances. The condition of the lungs and bronchi above described is peculiar, in that the upper part of both lungs is converted into firm, tough, pigmented and coarse fibrous tissue; but there is little or no macroscopic evidence to show that the fibrosis is of tubercular origin. There is little or no ulceration in the form usually seen even in cases of chronic tubercular phthisis, and practically no caseation. The bronchi embedded in the fibroid lung are much dilated, and in one or two instances enlarged, and form distinct pouch- like cavities. These bronchiectatic cavities are lined with a distinct smooth membrane, like a mucous membrane, and contain a certain amount of secretion. There appears to be no ulceration of their w alls, and no distinct evidence of tubercles in connection with them can be detected. If the fibroid condition were limited to the lower parts of the lungs, and not, as it is, especially seen in the upper parts, the appearances would be exactly what is seen in the rare cases of chronic non-tubercular fibroid phthisis with bronchiectasis. There can, however, be no doubt that the fibroid change is of tubercular origin when tlie condition of the lungs as a whole is considered, because (1) the fibroid change and bronchiec- tasis is specially seen in the apices of the lungs and on both sides ; (2) in some portions, after making several sections into the luug paren- chyma, small caseous foci can be detected ; (3) at the lower part of the fibrous areas distinct fibrous tubercles are present singly, in patches, aud