Age/sex: 22-year-old female
Size: 23.0 x 16.2 x 5.8 cm
The specimen shows a slice of the left lung in which the lower lobe is normal except for a small area of fibrosis in its superior segment (S). The upper lobe contains a large cavity (C). The pleura (P) is moderately thickened by fibrous tissue and includes a large space containing a small amount of blood clot (B) in its lower portion.
Cavitary tuberculosis with pneumothorax
Tuberculosis usually begins as a small focus of disease in the periphery of the lung, where it often heals without the individual developing symptoms. In some people, however, disease progresses and causes clinical findings such as fever, cough, and weight loss. The enlarging focus of disease can erode into the wall of a bronchus, allowing the necrotic (dead) material in its central portion to be coughed up. The resulting cavity is essential for the causative organism Mycobacterium tuberculosis, as it permits increased exposure to oxygen (which helps the organism to proliferate) and leads to spread to other individuals on minute fluid droplets originating on the inner lining of the cavity.
The use of pneumothorax - air in the pleural space between the lung and chest wall - as a treatment for tuberculosis became popular following the work of the Italian Carlo Forlanini (1847 鈥� 1918) in the late 1800s. Forlanini injected nitrogen into the pleural space to cause a collapse of the lung and any cavity it contained, theoretically promoting more rapid healing by decreasing oxygen delivery to Mycobacteria and by causing the cavity walls to stick together.
Plombage - insertion of foreign material such as acrylic (Lucite) balls or paraffin wax in the chest wall under the ribs - came to be used to avoid the repeated injections necessitated by reabsorption of the nitrogen. Both techniques were widely used in the first half of the 20th century, until supplanted by antibiotic therapy. Pleural fibrosis was a frequent complication of the procedure, as in this specimen.
Below: Forlanini administering artificial pneumothorax.
Source: Forlani administering artificial pneumothorax. Wellcome Collection.
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