A Further Study of Massive Collapse of the Lung

Certain difficulties were met with in the classification particularly regarding I1 b) collapse of the lung in connection with bronchiectasis, because of the fact that this had first an acute appearance but later persisted unaltered or showed progression, thus taking on a chronic course.Even some of the cases belonging to the other sub-groups of chronic collapse have had, judging from the history, an acute onset but subsequently taken on a chronic course.Regarding the course of the pulmonary collapse in the different cases the reader is referred to the case reports.I. Acute massive collapse of the lung a) Massive collapse of the lung arisen in connection with hsemoptysie Since our last publication several cases of acute collapse of the lung after hnemoptysis have been published (WILSON, KYLIX, CARL MULLER, SAMPSON).These cases have on the whole evidenced the same clinical and roentgenological character as those previously published by us.We are now in the position of publishing still another case.Case I .Admitted Sept. 28, 1928.Was laid up at, home for 6 weeks fromlfarch 1927 for a right-sided dry pleurisy.Has in other respects been quite well.On Sept. 27 1928 the patient suddenly coughed up about a tea-spoonful of light-coloured frothy blood.I n the evening and at night-time the patient continued t o cough up blood in quantities which he estimated to altogether more than half-a-litre.Was admitted the following day.General condition slightly impaired.Physical development satisfactory.Liings: On superficial examination no definite changes, possibly lagging behind of right lunq.Rtg.ex.Sept. 28, 1928 (Fig. 1).Medial portion of right diaphragm somewhat elevated.Heart and mediastinum slightly displaced to the right.No certain depression of right thorax.Right lung: a t the base and medially there is a dcnse shadow covering the outline of the heart.Laterally in I. 1 and I. 2 there are a couplr of ball-shaped opacities in the parenchyma.No changes are seen in the left 1 ung.On ordinary breathing very small chest movements, yet somewhat less on the right side.Medium dullness over the upper parts of the right lung and marked dullness over the lower and posterior parts.Weakened vesicular breathing over the upper part and markedly so over the lower part.Normal conditions in left lung.Circumference right 471/,, left 49 cm.Rtg. ex.Oct. 2 (Fig. 2).Since last examination the diffuse density within the basal parts of the lung-field has much increased both in intenbity and extent.This shadow is limited above by a fairly sharp line running from hilus laterally downwards towards the thoracic wall.At the same time the heart has been drawn over towards the right.