Three Cases of Abscess of the Lung
Authors: D. J. Williams
Journal: BMJ (1904)

MZXA JORNL cough was very troublesome, the slightest change of position bringing on a severe paroxysm, with copious fetid expectoration.On examina- tion of the chest the left side was found normal to percussion, whilst on the right side some impairment was met with all over the upper ipart, and dullness was found over the lower part, especially laterally, where the dull note extended as high as the level of the fifth rib.Akuscultation, which was extremely difficult owing to the very feeble condition of the patient and the paroxysms of cough, revealed rhonchi and crepitations over both sides of the chest and very much enfeebled lbreath sounds over the right base posteriorly.The other organs ap- lpeared fairly healthy, except that the urine contained a small quantity of albumen.Progress.-In this case I believed that I had to deal with a bronchi- .ectasisat the base of the right lung, the result most probably of a fetid -empyema which had burst into the bronchial tube.I felt that the only possible way of doing good in the case was to drain, and I therefore on several occasions, made exploratory punctures to locate the cavity or *¢avities.Distinctly to my surprise, however, I never could strike pus, 'nor could I feel that the exploring needle passed through dense tissue.I was content, therefore, to limit my treatment to antiseptic inhala- tions, and cardiac and general stimulants.The patient got rapidly -worse, the cough and fetid expectoration continued, some days more, some days less.Paresis of the right arm was noticed, and pericarditis -supervened, death occurring on April xith.Necropsy.-AprilI 2th.External appearances: Body somewhat 4emaciated, general pallor of surface, slight rigidity in lower limbs only.Thorax: Pericardium showed a recent purulent inflammation.Sac contained about half a pint of turbid fluid.The parietal layer was -somewhat thickened and covered with fibrinous exudation.The left pleural sac contained about 6 oz. of turbid fluid; no adhesions.The *right pleural sac showed a very peculiar condition.Over the upper lobe of the lung anteriorly the pulmonary pleura showed dense chronic thickening (k in.) and was firmly adherent to the thoracic wall.When *this was perforated an empyema cavity was exposed containing over 15 oz. of fetid brownish pus.This cavity was confined to the anterior portion of the upper lobe of the lung by dense fibrous adhesions, but -closer investigation showed that the pus had burrowed, both -into the chest wall in front and into the lung beiow.As regards the *chest wall, it had burrowed through the first and second right inter- -costal spaces, and hail caused gangrenous changes in the muscular tissues there.As regards the lung, it had burrowed through the fibrous adhesions into the anterior portion of the lower lobe.Right lung: On section this showed extensive collapse..The pleura -all round was much thickened, and the lobes were all adherent.In the lower lobe was found a cavity of about the size of a walnut, with soft gangrenous walls, and into this cavity opened three or four bronchi of about 4 in. in diameter, with greatly thickened walls.The entire right lung was much collapsed, so that the liver had risen high into the -thoracic cavity.The other organs showed nothing specially note- -worthy.