We have had abundant opportunity to observe early stages in the production of bronchiectasis and to study the much discussed pathogenesis of the condition.
The following figures show the predilection of bronchiectasis for the left lung and for the lower lobes: Bronchiectasis occurred 30 times in the left lung alone, 9 times in the right lung alone and 13 times in both lungs, the total being 52. Among 30 instances in which the lesion occurred only in the left lung, in 24 it was limited to the lower lobe, and in 15 of these 24 instances to the base of the lower lobe. Among 9 instances in which dilatation of bronchi occurred only in the right lung, it was limited to the lower lobe in 4 instances and to the base of the lower lobe in 2 of these 4 instances.
When the lesion is limited to the base of the lower lobes small bronchi with no recognizable cartilage in their wall are dilated to a diameter of from 3 to 6 cm. and are distended with thick mucopurulent fluid. The tenacious character of the bronchial contents and the action of gravity doubtless have a part in the production of the dilatation. In several instances dilatation of the bronchi was limited to the basal parts of both upper and lower lobes.
When bronchiectasis occurs throughout a whole lung, usually the left, or in both lungs, the lesion is more advanced and conspicuous (Fig. 26). There is diffuse dilatation of small and medium-sized bronchi. Dilated bronchi with deeply injected mucosa and filled with yellow mucopurulent fluid, are seen throughout the sectioned lung. A bronchus cut longitudinally may have a nearly uniform diameter of from 5 to 9 mm. for a distance of 5 or 6 cm., maintaining this diameter to within 1 cm. of the pleural surface, where normally only small bronchi occur.
More advanced bronchiectasis is represented by the occurrence of spherical bronchiectatic cavities, having a diameter from 1 to 2.5 cm. In some instances there have been two or three of these cavities but occasionally there may be many. Cylindrical dilatation of the bronchi usually occurs widely distributed in the lungs. In Autopsy 440 a small bronchus, cut longitudinally, was dilated to a diameter of 5 mm. for a distance of 5 cm. and terminated in a spherical cavity 2 cm. in diameter; there was another smaller spherical cavity nearby and dilated bronchi occurred elsewhere. In Autopsy 467, in the upper part of the lower lobe, two spherical cavities 1 and 1.5 cm. in diameter communicated with a bronchus of medium size.
Autopsies with bronchiectasis are listed in the order of the duration of illness to show the parallel increase in the severity of the lesion (Table LI). In 2 instances (Autopsies 244 and 314) bronchiectatic cavities surrounded by firm fibrous tissue have evidently existed before the onset of the fatal illness, which has lasted in one instance approximately four and in the other six days; these autopsies have been omitted from the table.
The table shows that bronchiectasis observed within twelve days after onset of illness with symptoms of influenza is moderately advanced and almost invariably limited to the left lower lobe and usually to the base of the lobe. Advanced dilatation, indicated by the formation of spherical or cylindrical cavities, occurs with increasing frequency as the duration of the respiratory disease increases.
Bronchiectasis has been almost invariably associated with purulent bronchitis. The dilated bronchi contain mucopurulent material and throughout the lungs the same condition is usually widespread. Among 137 instances of purulent bronchitis bronchiectasis consequent upon influenza has been present in 50.
| Table LI | |||||
|---|---|---|---|---|---|
| NO. OF AUTOPSY | DURATION OF ILLNESS IN DAYS | TYPE OF PNEUMONIA | LOCATION OF BRONCHIECTASIS | CHARACTER OF BRONCHIECTASIS | BACTERIA IN BRONCHUS |
| 394 | 5 ? | Broncho | Rt. base | Dilatation | |
| 359 | 7 + | Lobar and broncho | Lt. lower lobe | Dilatation | |
| 322 | 8 | Abscess (staph.) | Lt. base | Dilatation | |
| 325 | 8 | Interst. suppuration | Lt. base | Dilatation | S. hem., B. inf., staph. |
| 352 | 8 | Lobar and broncho | Lt. lower lobe | Advanced dilatation | |
| 429 | 8 ? | Broncho | Rt. base | Dilatation | |
| 288 | 10 | Abscess | Lt. base | Dilatation | S. hem., B. inf. |
| 374 | 10 | Lobar and broncho | Rt. and lt. lungs | Advanced dilatation | |
| 376 | 10 | Abscess | Lt. base | Dilatation | S. hem. |
| 437 | 11 | Lobar | Rt. lower lobe | Advanced dilatation | |
| 482 | 11 | Broncho | Lt. base | Dilatation | B. inf., Pneum. IV, S. hem. |
| 489 | 11 | Lobar and broncho | Lt. lung | Dilatation | B. inf., Pneum. IV. |
| 287 | 12 | Lobar and broncho | Lt. lower lobe | Advanced dilatation | Pneum. IV., B. inf., staph. |
| 289 | 12 | Broncho | Lt. lower lobe | Advanced | Pneum. IV., B. inf. staph. |
| 295 | 12 | Interst. sup. and abscess | Rt. lung | Advanced dilatation | S. hem., B. inf. |
| 336 | 12 | Broncho | Lt. base | Dilatation | |
| 375 | 12 | Broncho | Rt. and lt. bases | Dilatation | |
| 422 | 12 ? | Lobar and broncho | Lt. base | Dilatation | |
| 381 | 13 | Abscess | Lt. base | Spherical | |
| 391 | 13 | Lobar and broncho | Lt. lung | Dilatation | |
| 401 | 14 ? | Lobar and broncho | Rt. and lt. lungs | Spherical | |
| 402 | 14 | Chronic broncho | Rt. lower lobe | Dilatation | |
| 410 | 14 ? | Abscess | Rt. upper lobe | Dilatation | |
| 333 | 15 | Abscess (staph.) | Lt. upper lobe | Dilatation | S aur., B. inf. S. hem. |
| 389 | 15 | Interst. suppuration | Lt. lung | Advanced dilation | |
| 412 | 15 | Lobar and broncho | Lt. lower lobe | Cylindrical | |
| 398 | 16 | Broncho | Rt. and lt. lungs | Advanced dilatation | |
| 423 | 16 | Broncho | Lt. base | Dilation | |
| 488 | 16 | Abscess | Lt. lower lobe | Dilatation | S. hem., Pneum. atyp. II. |
| 312 | 17 | Broncho | Rt. and lt. lungs | Dilatation | S. hem., B. inf. staph. |
| 372 | 17 | Broncho | Rt. lung | Dilatation | |
| 385 C | 17 | Interst. suppuration | Lt. base | Dilatation | |
| 448 | 17 | Broncho | Lt. lung | Dilatation | |
| 460 | 17 | Abscess | Lt. lower lobe | Spherical | S. hem., B. inf., staph. |
| 291 | 18 | Broncho | Lt. base | Advanced dilatation | B. inf., staph. |
| 296 | 18 | Abscess | Lt. base | Dilatation | S. hem., B. inf., |
| 387 | 19 | Abscess | Rt. and lt. lungs | Advanced dilatation | S. hem., B. inf., S. aur. Pneum. II. |
| 421 | 19 | Chronic broncho | Rt. lung | Advanced dilatation | |
| 440 | 19 | Chronic broncho | Rt. and lt. lungs | Spherical | B. inf., S. aur. |
| 419 | 20 | Broncho | Rt. lung | Dilatation | Pneum. II, B. inf. |
| 463 | 20 | Chronic broncho | Rt. and lt. lungs | Spherical | B. inf., staph., Pneum. IV |
| 431 | 23 | Chronic broncho | Lt. base | Dilatation | |
| 468 | 23 ? | Lobar and broncho | Lt. lung | Dilatation | S. aur., B. inf., S. vir. |
| 465 | 25 ? | Broncho | Lt. base | Dilatation | S. hem., B. inf., staph., S. vir. |
| 445 | 27 | Broncho | Lt. lower lobe | Spherical | S. aur. |
| 449 | 27 | Abscess | Rt. and lt. lungs | Spherical | S. hem., B. coli. |
| 378 | 28 | Abscess | Lt. base | Cylindrical | S. hem., B. inf., Pneum. atyp. II. |
| 473 | 28 | Chronic broncho | Lt. lung | Advanced dilatation | B. inf., S. vir., staph., M. catarr. |
| 425 | 29 | Abscess (staph.) | Rt. and lt. lungs | Cylindrical | |
| 467 | 30 | Abscess | Rt. lower lobe | Spherical | S. hem., B. inf. |
| 472 | 37 | Chronic broncho | Rt. and lt. lungs | Advanced dilatation | B. coli |
| 487 | 55 | Abscess | Rt. and lt. lungs | Cylindrical | B. inf. S. hem. |
The bacteriology of autopsies with bronchiectasis is shown in Table LII.