An observation on the healing of tuberculous cavities: A case report and a comparison

An Observation on the Healing of Tuberculous Cavities: A Case Report and a Comparison By G. A. M. H A L L The Cornish Riviera Sanatorium, Rosehill, Penzance That cavities close and heal as the result of the obstruction of their draining bronchus followed by absorption of air from within the cavity, rather than by compression and apposition of their walls, is now so widely accepted as a working hypothesis that attempts are made to close such bronchi by mechanical and chemical means. The case here briefly reported shows how a cavity, uncontrolled by an artificial pneumothorax, closed rapidly after an accident which caused the kinking of its draining bronchus. A married woman aged 38 had shown symptoms of pulmonary tuberculosis for six months. In spite of bed rest at home, when first seen in August, I936 , her temperature reached Io2 ~ F. each evening and she raised from 3-4 oz. of sputum daily. She weighed 6 st. 5 lb. The left upper lobe was the seat of caseous tuberculosis with multiple cavities. An artificial pneumothorax was established, but, though successful in reducing the temperature and quantity of sputum, it failed to control a large cavity in the mid-zone of the diseased lobe which was held out by a dense adhesion to the apex. The situation in February 1937 is shown by the x-ray plate reproduced as Fig. I. At this time the temperature remained in the neighbourhood of IoI ~ F. and about ~ oz. sputum was raised daily.

Fig. L Following a refill in April, i937, pain occurred in the chest, the temperature rose, and a pleural effusion developed. Fluid was removed in quantities up to 300 c.c. and air replacements given, but the pneumothorax was gradually lost till only ioo c.c. could be given. The temperature remained high till July, when it was no longer possible to find a free space for the injection of air. In spite of this the condition of the patient started to improve steadily from this time. The sputum disappeared abruptly and the temperature became

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normal over a period of two weeks. Weight was steadily gained and the patient made an excellent recovery. She remains short of breath and wheezy due to a distortion of the trachea, but is otherwise well.

Fig. 2.

A study of the film reproduced in Fig. 2 suggests the mechanism by which healing was brought about. The strong retraction of the lung to the chest wall by the obliterating pleurisy has caused a kinking of the bronchus draining the cavity and so brought about its healing, an event which could hardly have been hoped for by the continuation of the artificial pneumothorax.

Fig. 3-

The film shown in Fig. 3 is reproduced as a contrast to show how even the complete collapse of a lung by artificial pneumothorax may fail to close a cavity. My thanks are due to Dr Francis Chown for permission to record this case, which occurred under his care.