A study of the pathology and pathogenesis of bronchiectasis.

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2)38F. WHITWELLTABLE IIIPATHOLOGY OF BRONCHIECTASISFollicular I Saccular Atelectatic84% left-sided 72% left-sided 36% left-sidedIso'ated bronchi affected Isolated bronchi affected All bronchi involvedChronic inflammatory changes in bronchi Chronic inflammatory changes in bronchi Variable degree of inflammatory change,and bronchioles, with formation of lymph and saccules, no lymph follicle formation lymph follicles sometimes seenfolliclesDestruction of elastic tissue and muscle, some Little destruction of supporting tissues except Variable amount of destruction, sometimesdestruction of cartilage and mucous glands within saccules, where none remain very littleBronchial epithelium intact and smooth, Bronchial epithelium intact but polypoid. Bronchial epithelium usually intact andsmall ulcerations in bronchioles. No Some ulcerations in saccules and promi- smooth. Few ulcerations, no squamoussquamous metaplasia nent squamous metaplasia metaplasiaBronchio'es narrowed or obliterated Bronchioles obliterated Bronchioles patentAlveoli mostly well aerated, but some inter- Alveoli well aerated, no chronic interstitial Marked alveolar collapse, uniform throughstitialpneumonia around affected bronchi pneumonia. Some compression collapse out lobe. Little inflammatory change inand bronchioles. Some compression around saccules collapsed alveoli, but some fibrosiscollapse around areas of pneumoniaClinical FindingsAge at onset of symptomsDuration of symptomsAge at time of operationIllness at onset of symptomsBronchogramsNasal sinus involvementClubbing__TABLE IVCLINICAL ASPECTS OF DIFFERENT TYPES OF BRONCHIECTASISFollicularSaccular53% under 3 yrs. 78% under 7 25% complained of symptoms allyrs. their lives. 70% began symptomsbetween 13 and 25 yrs.1-15 yrs. 50% for 1-5 yrs. 2-20yrs. 50%for2-6yrs.Mainly 6-11 yrs. old, with gradual None under 15 yrs., mostly bedecreaseup to 20 yrs. None tween 15 and 25 yrs., with a fewover 20 yrs.cases in older groups~~~~~IVague onset in 25%. Measles andy Vague onset in 45% (includingor whooping-cough in 45%. 25% who had symptoms allPrimary bronchopneumonia in their lives). Unspecified pneumoniain 56%. No association20%with measles or whooping-coughI _ .1Usually cylindrical, sometimes SaccularatelectaticOver 70%Under 50%Over 70()75%1-Atelectatic20% under 3 yrs. 70, under 7yrs.1-15 yrs. 33% for 1-3 yrs.Mostly between 5 and 10 yrs.,but no sudden fall-off of olderpatientsVague onset rare. Measles orwhooping-cough in 50%/; primarybronchopneumonia in 25%AtelectaticInfrequentInfrequentoperation specimens, such as has been seen in thepresent series, and which has frequently beendescribed in the literature.SUMMARYThe investigation has consisted of the examinationof 200 consecutively removed bronchiectatic lungsand lobes. Methods used consisted of neopreneinjection casts of bronchial trees, large histologicalsections of entire lobes, and detailed dissections ofbronchial trees with histological examinations ofselected areas.The lobar, segmental, and intra-segmental distributionof the lesions have been described (seeTables I and 11, and Fig. 10).More than half the specimens belonged to oneor other of three rather distinctive types of bronchiectasis,which have been called follicular,saccular, and atelectatic bronchiectasis, and theirpathology, clinical features, and pathogenesis hasbeen discussed (see Figs. 21, 30, and 35, andTables I II and IV).Finally, current theories of pathogenesis havebeen criticized in the light of the present enquiry.This work has been only made possible through theco-operation of the staff of the Surgical Chest Centre,Broadgreen Hospital. In addition I would like to thankMr. H. Morriston Davies, Mr. F. R. Edwards, and Dr.Robert Coope for many valuable discussions on medicaland surgical aspects of bronchiectasis. I wish also toacknowledge my indebtedness to Dr. Rachel M. Rawcliffefor her assistance in the preparation of neoprenecasts and in the tabulation of case-records, and toDr. P. J. Taylor for correction of the MS.
PATHOLOGY AND PATHOGENESIS OF BRONCHIECTASIS239REFERENCESAllison, P. R., Gordon, J., and Zinnemann, K. (1943). J. Path. Ba t.,55, 465.Andrus, P. M. (1937). Amer. Rev. Tuberc., 36, 46.(1940). Ibid., 41, 87.Baarsma, P. R., and Dirken, M. N. J. (1948). J. thorac. Surg., 17,238.- and Huizinga, E. (1948). Ibid., 17, 252.Ballon; H., Singer, J. J., and Graham, E. A. (1931). Ibid., 1, 154.Boyd, G. L. (1935). J. Amer. med Ass., 105, 1832.Brock, R. C. (1946). The Anatomy of the Bronchial Tree. London.-(1950). Thorax, 5, 5.Broman, 1. (1923). Anat. Anz., 57, Suppl. (Verh. anat. Ges.), p. 83.Quoted by Engel.Churchill, E. D. (1949). J. thorac. Surg., 18, 279.-and Belsey, R. (1939). Ann. Surg., 109, 481.Coope, R. (1948). Diseases of the Chest, 2nd ed. Edinburgh.Cruikshank, A. H. (1948). J. Path. Bact., 60, 520.Engel, S. (1947). The Child's Lung. London.Erb, I. H. (1933). Arch. Path., 15, 357.Ewart. W. (1900), Allbutt and Rolleston's System of Medicine, 2nded., vol. 5, p. 127 seq. London.Fleischner, F. (1940). Amer. Rev. Tuberc., 42, 297.Jackson, C., and Jackson, C. L. (1932). J. Amer med. Ass., 99, 1747.Laennec, R. T. H. (1819). Dc L'Auscultation Mediate. Paris.Lander, F. P. L. (1946). Thorax, 1, 198.and Davidson, M. (1938). Brit. J. Radiol., 11, 65.Lisa, J. R., and Rosenblatt, M. B. (1943). Bronchiectasis. London.MacCallum, W. G. (1940). Textbook of Pathology, 7th ed. Philadelphia.McNeil, C., Macgregor, A. R., and Alexander, W. A. (1929). Arch.Dis. Childh., 4, 170.Mallory, T. B. (1947). New Engi. J. Med., 237, 795.Maximow, A. A., and Bloom, W. (1942). Textbook of Histology,4th ed. Philadelphia.Miller, W. S. (1947). The Lung, 2nd ed. Springfield, Illinois.Moore, J. R., Kobernick, S. D., and Wiglesworth, F. W. (1949).Suirg. Gynec. Obstet., 89, 145.Nelson, J. B. (1946). J. exp. Med., 84, 7 and 15.Ochsner, A. (1930). Amer. J. med. Sci., 179, 388.Ogilvie, A. G. (1941). Arch. intern. Med., 68, 395.Opie, E. L. (1928). Arch. Path., Chwago, 5, 285.Overholt, R. H., Betts, R. H., and tods F. M. (1947). Dir. Chest,13, 583.Peroni A. (1934). Arch. Otolaryng., 19, 1. Quoted by Samson.Perry, K. M. A., and King, D. S. (1940). Amer. Rev. Tuberc., 41,531.Reid, L. McA. (1950). Thorax, 5, 233.Riviere, C. (1905). St. Bart's Hosp. Rep., 41, 123.Robinson, W. L. (1933). Brit. J. Surg., 21, 302.(1939). Amer. J. Path., 15, 638.Samson, P. C. (1940). J. thorac. Surg., 9, 679.Schmidt, H. W. (1947). Ann. Otol., St. Louis, 56, 793.Tannenberg, J., and Pinner, M. (1942). J. thorac. Surg., 11, 571.Van Allen, C. M., and Jung, T. S. (1931). Ibid., 1, 3.Warner, W. P., and Graham, D. (1933). Arch. intern. Med., 52, 888.Watts, C. F., and McDonald, J. R. (1948). Arch. Path., Chicago,45, 742.Weinberg, J. (1937). J. thorac. Surg., 6, 402.Williams, C. J. B. (1838). Lond. med. Gaz., n.s. 1, 913.Willis, R. A. (1 948). Pathology of Tumours. London.
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A study of the pathology and pathogenesis of bronchiectasis.

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