Page 313 (image) |
Previous | 318 of 811 | Next |
|
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
Loading content ...
May, 1947 CYSTS OF THE LUNG—MOORE 311 and she remained well except for a hacking cough, which was thought to be due to diseased tonsils. A tonsillectomy was done in 1936, but the cough continued. In March and April, 1938, she ran a low-grade fever, and her mother noticed that her breath had a foul odor. On April 10, 1938, she suddenly spat up a large quantity of foul pus, and had continued to do so. About this time, her mother first noticed clubbing of the fingers. She had had no illness except measles prior to the onset of her present illness. Physical examination revealed a well developed girl of 11, who did not appear very ill. The fingers and toes showed moderate clubbing. There was diminished expansion of the lower half of the left side of the chest. The percussion note was flat below the eighth rib anteriorly and the fifth thoracic vertebra posteriorly. Over this area the breath sounds were absent, and the voice sounds were not transmitted. The scar of the former thoracotomy was present. The hemoglobin was 68 per cent, the erythrocyte count 3,650,000, and the leukocyte count 11,200. The posterior-anterior and lateral roentgenograms (fig. 1 and 2) showed a rounded cavity in the base of the left side of the chest, containing air and fluid. Examination of her sputum revealed fu-sospirochetes and many mixed organisms, but no tubercle bacilli. A diagnosis of a chronic empyema with a broncho-pleural fistula was made by me. On June 30, 1938, a thoracotomy was done by resecting a portion of the tenth rib in the scapular line. When the parietal pleura was incised, no free pleural space was encountered, and no empyema was found, although pus had been obtained by aspiration at this site. Pus was again aspirated, and the thin wall of what appeared to be a pulmonary abscess was incised. A considerable amount of putrid pus was aspirated. In my operative notes, I stated that Fig. 1. (Case 1) Posterior-anterior roentgenogram, showing a large cavity in the left lower thorax, with a fluid level. the wall of the abscess was smooth, glistening, and red. No necrotic tissue and no trabeculations were seen. This appearance is not typical of a pulmonary abscess, and made me believe that this was an infected cyst of the lung, which would subsequently require lobectomy. A portion of the wall of the cyst was removed for examination. The pathologist did not recognize the true nature of the lesion. The patient had a very stormy convalescence. A high fever developed, and she was extremely ill. A roentgenogram revealed a density in the left upper part of the chest, which was proved to be a mesial empyema. This was drained by a closed thoracotomy in the fifth interspace posteriorly on July 26. The pus removed was putrid and contained fusospir-ochetes and mixed organisms. After this procedure the girl gradually improved, and was discharged from the hospital on August 18, 1938. Continuous drainage of the infected cyst was maintained by means of a rubber tube. The patient remained well, attended school the next year, and returned to Biltmore Hospital on June 2, 1939. Roentgenograms showed the same rounded cavity at the left base without a fluid level. On June 3, 1939, the left phrenic nerve was crushed under local anesthesia. On June 5, under intratracheal cyclopropane and ether anesthesia, a lobectomy of the left lower lobe was attempted. The lobe was found to be densely adherent; it was freed with difficulty and with considerable loss of blood. By the time the lobe was separated from the diaphragm and the chest wall, the patient began to show signs of shock. Bleeding vessels were ligated; a gauze pack was inserted, and the wound partly closed. She rallied quickly after a transfusion of whole blood. On June 19, under intratrachael cyclopropane and ether anesthesia, the lobectomy was completed. Fig. 2. (Case 1) Lateral roentgenogram, showing the same cavity occupying the space of the left lower lobe. Notice the absence of inflammatory zone around the cavity.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1947 |
Identifier | NCHH-17-008 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 8 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-008.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-008 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Description
Fixed Title * | Page 313 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1947 |
Identifier | NCHH-17-008-0323 |
Form General | Periodicals |
Page Type | all; all images; x-ray; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed81947medi_0323.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 8 |
Issue Number | 5 |
Page Number | 313 |
Health Discipline | Medicine |
Full Text | May, 1947 CYSTS OF THE LUNG—MOORE 311 and she remained well except for a hacking cough, which was thought to be due to diseased tonsils. A tonsillectomy was done in 1936, but the cough continued. In March and April, 1938, she ran a low-grade fever, and her mother noticed that her breath had a foul odor. On April 10, 1938, she suddenly spat up a large quantity of foul pus, and had continued to do so. About this time, her mother first noticed clubbing of the fingers. She had had no illness except measles prior to the onset of her present illness. Physical examination revealed a well developed girl of 11, who did not appear very ill. The fingers and toes showed moderate clubbing. There was diminished expansion of the lower half of the left side of the chest. The percussion note was flat below the eighth rib anteriorly and the fifth thoracic vertebra posteriorly. Over this area the breath sounds were absent, and the voice sounds were not transmitted. The scar of the former thoracotomy was present. The hemoglobin was 68 per cent, the erythrocyte count 3,650,000, and the leukocyte count 11,200. The posterior-anterior and lateral roentgenograms (fig. 1 and 2) showed a rounded cavity in the base of the left side of the chest, containing air and fluid. Examination of her sputum revealed fu-sospirochetes and many mixed organisms, but no tubercle bacilli. A diagnosis of a chronic empyema with a broncho-pleural fistula was made by me. On June 30, 1938, a thoracotomy was done by resecting a portion of the tenth rib in the scapular line. When the parietal pleura was incised, no free pleural space was encountered, and no empyema was found, although pus had been obtained by aspiration at this site. Pus was again aspirated, and the thin wall of what appeared to be a pulmonary abscess was incised. A considerable amount of putrid pus was aspirated. In my operative notes, I stated that Fig. 1. (Case 1) Posterior-anterior roentgenogram, showing a large cavity in the left lower thorax, with a fluid level. the wall of the abscess was smooth, glistening, and red. No necrotic tissue and no trabeculations were seen. This appearance is not typical of a pulmonary abscess, and made me believe that this was an infected cyst of the lung, which would subsequently require lobectomy. A portion of the wall of the cyst was removed for examination. The pathologist did not recognize the true nature of the lesion. The patient had a very stormy convalescence. A high fever developed, and she was extremely ill. A roentgenogram revealed a density in the left upper part of the chest, which was proved to be a mesial empyema. This was drained by a closed thoracotomy in the fifth interspace posteriorly on July 26. The pus removed was putrid and contained fusospir-ochetes and mixed organisms. After this procedure the girl gradually improved, and was discharged from the hospital on August 18, 1938. Continuous drainage of the infected cyst was maintained by means of a rubber tube. The patient remained well, attended school the next year, and returned to Biltmore Hospital on June 2, 1939. Roentgenograms showed the same rounded cavity at the left base without a fluid level. On June 3, 1939, the left phrenic nerve was crushed under local anesthesia. On June 5, under intratracheal cyclopropane and ether anesthesia, a lobectomy of the left lower lobe was attempted. The lobe was found to be densely adherent; it was freed with difficulty and with considerable loss of blood. By the time the lobe was separated from the diaphragm and the chest wall, the patient began to show signs of shock. Bleeding vessels were ligated; a gauze pack was inserted, and the wound partly closed. She rallied quickly after a transfusion of whole blood. On June 19, under intratrachael cyclopropane and ether anesthesia, the lobectomy was completed. Fig. 2. (Case 1) Lateral roentgenogram, showing the same cavity occupying the space of the left lower lobe. Notice the absence of inflammatory zone around the cavity. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-008.pdf |
Document Sort | all; nchh-17 |
Article Title | Congenital Cysts Of The Lung |
Article Author | Julian A. Moore |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-008 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Tags
Comments
Post a Comment for Page 313 (image)