Obliterative Bronchitis and Bronchiolitis with Bronchiectasis*

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360 expiration films should be taken to demonstrate the air-trapping of emphysema with- in the parenchyma surrounding ectatic bronchi. Obviously, when patients with lobes which are opaque are being investi- gated, this need not be done since a carni- fied or "wet lung" can be assumed to be present. A patient who on plain x-ray film shows localized hyperlucence should have expiration x-ray films routinely and bron- chography to demonstrate the air-trapping of emphysema. Studies should then be carried out to show the bronchial occlusive processes. At thoracotomy, the lobes or lungs, which radiographically showed bronchiec- task with surrounding hyperlucent lung, appear emphysematous and do not collapse readily. This is due to the check-valve pathophysiology of collateral air-flow through the pores of Kohn, and its result- ant air-trapping.""'O'llllS SUMMARY 1. The relative frequency of obliterative bronchitis and bronchiolitis in association with bronchiectasis is pointed out. 2. With obliteration of bronchial conduits, there is initiation of collateral ventilation of the parenchyma surrounding the obliterated bronchi. Emphysematous changes follow prolonged collateral ventilation. 3. Radiographic hyperlucence, with air- trapping in the parenchyma surrounding ectatic bronchi, suggests the association of obliterative bronchitis with the bronchiectasis. 4. When the associated conditions in- volve an entire lung, the radiographic ap- pearance is that of the so-called "idiopathic unilateral hyperlucent lung." 1. Se seiiala la relativa frecuencia de la bron- quitis y la bronquiolitis obliterante en asociaci6n con bronquiectasia. 2. A1 obliterarse 10s conductos bronquiales se inicia una ventilaci6n colateral del partnquima que radea 10s bronquios obliterados. La ventila- ci6n colateral prolongada conduce a cambios en- fisematosos. Downloaded From: http://intl.chestjournal.chestpubs.org/ on 06/23/2013 MORRIS M. CULINER Diseases of the Chest 3. El aspect0 excesivamente translhcido, con atrapamiento de aire en el partnquima que cir- cunda 10s bronquios ecthsicos sugiere la bron- quitis obliterante con bronquiectasia. 4. La asociaci6n de esas condiciones a1 com- prometer todo un pulm6n produce la apariencia del llamado "pulm6n hiperlhcido unilateral idio- phtico." L'auteur insiste sur la relative frtquence de la bronchite obstructive et de la bronchiolite, assocites B la bronchectasie. 2. Par obliteration des conduits bronchiques, il y a introduction d'une ventilation collattrale du parenchyme avoisinant les bronches oblittrkes. Des alterations ernphystmateuses suivent la ventilation collattrale prolongte. 3. Une hyperclartt radiographique, avec trapping de l'air dans le parenchyme avoisinant les bronches, Cvoque l'association de bronchite obstructive et de bronchectasie. 4. Lorsque les conditions assocites atteignent le poumon en entier, l'apparence radiographique est celle de la prttendue "hyperclartt unilattr- ale idiopathique du poumon." 1. Die relative Haufigkeit obliterativer Bron- chitis und Bronchiolitis in Verbindung mit Bron- chiektasen wird hervorgehoben. 2. Mit der Obliteration bronchialer Luftwege beginnt eine kollaterale Ventilation des die ob- literierten Bronchen umgebenden Parenchyms. Emphysematose Veranderungen schliessen sich an eine lngerdauernde kollaterale Ventilation an. 3. Rontgenologisch erhohte Strahlentranspar- enz mit Luftstauung in dem die enveiterten Bronchien umgebenden Gewebe lafit vermuten, daP eine Verkniipfung von obliterativer Bron- chitis mit der Bronchiektasie besteht. 4. BetriiTt die Krankheitsverkniipfung eine ganze Lunge, so entspricht das rontgenologische Erscheinungebild demjenigen der sogenannten "idiopathischen unilateralen vermehrt strahlen- durchlassigen Lunge." 1 REYNAUD, A.,,C.: "Memoire sur l'obliteration des Bronches, Mcmoircs dc I'Acadcmic Royalc dc Mcdccinc, Paris, 4: 167, 1835. 2 CHURCHILL, E. D.: "The Architectural Basis of Pulmonary Ventilation," Ann. Surg., 137 : 1, 1953. 3 CHURCHILL, E. D.: "The Segmental and Lobular Physiology and Pathology of the Lung," 1. Thor. Surg., 18: 279, 1949. 4 DARKE, C. S., CHRISPIN, A. R. AND SNOWDEN, B. S. : "Unilateral,, Lung Transradiancy : A Physiological Study, Thorax, 15 : 74, 1960. 5 MARGOLIN, H. N., ROSENBERG, L. S., FELSON, B. AND BAUM, G.: "Idiopathic unilateral Hyperlucent Lung: A Roentgenologic Syndrome,"
44 No. October 19k3 BRONCHITIS AND BRONCHIOLITIS WITH BRONCHIECTASIS 361 Am. 1. Roent., Radium Therapy and Nucleat. Med., 82 : 63, 1959. 6 MACLEOD, W;, M.: "Abnormal Transradiancy of One Lung, Thorax, 9 : 147, 1954. 7 SWYER, P. R. AND JAMES, G. G. W.: "A Case of Unilateral Pulmonary Emphysema," Thorax, 8:133, 1953. 8 DORNHORST, A. C., HEAP, P. J. AND SEMPLE, J. G.: "Unilateral 'Emphysema'," Lancet, 2: 873, 1957. 9 REID, L. Md.: "Reduction in Bronchial Subdivision in Bronchiectasis," Thorax, 5 : 233, 1950. 10 CULINER, M. M. AND GRIMES, 0. F.: "Localized Emphysema in Association with Bronchial Cysts or Mucoceles," J. Thor. Cardiovas. Surg., 41:306, 1961. 1. Roent., Radium Therapy and Nuclear Med., 85:246, 1961. 12 vAN ALLEN, C. M. AND LlN~sK~, G. M.: "Collateral Respiration in the Lung," Surg., Cyn. Obs., 53: 16, 1931. LAY, J. H.: "Elimination and Transport of Mucus in the Lung," J. Thor. Surg., 32:661, 1956. 14 KOHN, H. N.: Miinch Med. Wochenschr., 42: 3, 1893. 15 MCLEAN, K. H.: "The Pathogenesis of Pulmonary Emphysema," Am. 1. Med., 25 : 66 1, 1958. 11 CULINER, M. M. AND REICH, S. F.: "Collateral Ventilation and Localized Emphysema," Am. For reprints, please write Dr. Culiner at 2233 Post Street, San Francisco. VENTILATORY EFFECTS OF "THERMO Flfty patients with chronlc bronchitis, bronchial asthma, and chronic dlffuse obstructlve pulmonary emphysema, had pulmonary functlon studies performed before and immedlately after a 15-mlnute lnhalatlon of Isoproterenol-HC1, a sympathomlmetlc drug wlth bronchodilator properties, in a super- heated mixture ("Thermo-Fog") of 40 per cent propylene glycol in isotonlc sallne solution. This therapy resulted in a slgniflcant enhancement of the average maximum minute ventilatlon and shorten- Ing of the vltal capaclty tlme, with less definite 13 HUPPLER, E. G., CLAOETT, 0. T. AND GRIND- FOG AS A BRONCHODILATOR VEHICLE CARCINOMA OF ESOPHAGUS effects upon the group average vltal capaclty. breathlng reserve ratlo and tlmed I-second vltal capaclty values. Sixty per cent of the patients showed indivldual vital capacity rlses and 72 per cent had indivldual rises In maximum mlnute ventllatlon figures. There were no adverse cllnlcal edtects and the aerosol was well tolerated. COHEN, B.M. AND CRANDALL, C.: "Ventilatory Effects of 'Themo-Fog' as a Bronchodilator Vehicle," Brit. J. Dir. Che~t, 57:86, 1963. A case of carcinosarcoma of the esophagus In a currence 556 years after operatlon. The llterature 54-year-old white man is recorded. The tumor was pertainlng to carcinosarcoma of the esophagus was a polypoid mass. 6 cm. In dlameter, which was at- revlewed. Twenty-eight cases have been reported. tached by a relatlvely long and narrow pedicle to the wall of the lower thlrd of the esophagus. Local All but slx were necropsy cases. MOORE, T.C.. BATTERSBY, J.S.. VLLIOS, F., AND LOEHR, resection of the tumor was carried out wlth a wlde W.M.: "Carcinosarcoma of the Esophagus. J. Tbor. and cuff of esophageal mucosa at the base of the pedlcle. The patlent Is allve and free of known tumor re- Cardioval. Sur., 45:281, 1963. TUBERCULOUS SUB-CUTANEOUS ABSCESSES (TUBERCULOUS GOMMA) Eight cases wlth subcutaneous or musculocutan- pus from the abscess posltive for tubercle bacllll. eous tuberculous abscesses are described in detail. There 1s also Included a review of the llterature on All the patlents Improved on chemotherapy. LAVAL. P.. WEILLER, R.. BALOZET, P. AND XAU, P.: "La thls rare condition. In only one lnstance was the Tuberculov Gomwuv." Rev. de Tub. er 1135, 1962. de Pneu., 26: ANALYSIS OF RESULTS OF PARTIAL AND TOTAL UPPER LOBE LOBECI'OMIES Immediate and long term results of partial and performed for varlous types of tuberculous lesions. total upper lobe lobectomles are analyzed. The data BOCQUET, A., MAGNIN, F. AND MARION, L.: "Resultats were collected from three different French hospltals Comparatifs des Excrc~s Partielles ou Completes du Lobe and includes a study of 2500 operatlons which were Supericur." REP. de Tub, el de Pneu.. 26:1027. 1962. Downloaded From: http://intl.chestjournal.chestpubs.org/ on 06/23/2013
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Obliterative Bronchitis and Bronchiolitis with Bronchiectasis*

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