- Email: [email protected]
Unusual resolution of a tuberculous cavity
CLINICAL
CASES
297
Further treatment considered, but fortunately not necessary to attempt to carry out, was the desensitisation of the skin with X-rays in half-pastille doses. However, whether this would have proved practical with the necessity of repeated trauma and the obvious difficulty in repeating desensitisation doses is problematical. M y gratitude is due to Dr. A. Bingham o f the Manchester and Salford Skin Hospital, who saw this case, and to Dr. H, G. Trayer, the Medical Superintendent, for his advice and help on all occasions.
U N U S U A L R E S O L U T I O N OF A T U B E R C U L O U S CAVITY By A. S. H E R I N G T O N ,
B.c .(cAMB.) Assistant Medical Officer, King Edward VII. Sanatorium, Midhurst.
THE particular interest of this case is radiological. It will be seen from the series of X-ray films (Figs. I to 3) that at the time of the earliest film there was a left subclavicular lesion containing a cavity with a fluid level. This cavity became smaller and disappeared; and the final picture shows the lesion as a localised homogeneous shadow o f " ground glass " appearance. No cavity is now visible--nor can it be seen on a film taken with increased penetration. The final appearance, in fact, resembles an Assman's focus: if the films were to be arranged in the reverse order they would exactly represent the process of cavitation in an Assman's focus. That the opposite process may occur seems worthy of record. The following is a brief clinical account of the case: The patient is a single woman, a schoolmistress, aged 53. She had a heakhy childhood, and a healthy adult life until the time of the war, when she became very " run down," and subsequently she has suffered from recurrent attacks of biliousness and " colitis." In 193o , at the age of 46, her condition was investigated at a London hospital, and it is reported that she had " a marked secondary anaemia and hypotonic gastro-intestinal tract," but that " there was nothing to suggest tuberculosis at that time." There is no family history of phthisis; nor can any history of contact be elicited. The first sign of her present illness appears to have occurred in June, I936 , when she had a " gastric attack," which confined her to bed for
298
THE
BRITISH JOURNAL
OF TUBERCULOSIS
five days. This differed from previous bilious attacks in being accompanied by feverishness (temperature Io2 ° to Io3 °) and night sweats, and left her with a slight dry cough. In August, i936 , a similar attack occurred: and in September she became feverish for a third time, when her cough became worse and a little sputum developed. This was examined and found to be negative, but her chest w a s X-rayed and the diagnosis of pulmonary tuberculosis was made. She was in bed for ten days, and then went away for a holiday to Devonshire, where her cough entirely disappeared. In December, i936 , she consulted Dr. S. R. Eastwood, as a result of which she was ordered complete rest in bed. Fig. 2 shows an X-ray of her chest condition at that time. Her sedimentation rate (i hour Westergren) was then Io ram. There was no sputum and the temperature was subnormal. The patient remained on strict rest until she was admitted to the King Edward VII. Sanatorium, Midhurst, on April 2. The cavity had then disappeared (Fig. 3). There were a few fine crepitations in the left subapical region. Her sedimentation rate (½ hour micro method) was 25 ram. After two months, during which time she was slowly advanced in the sanatorium rdgime, her Sedimentation rate dropped to 15 ram., t h e physical signs disappeared and she was able to walk one and a half miles a day without reaction. She has had no cough or sputum and no rise of temperature above normal. The chest lesion would now appear to be stable. I wish to thank Dr. S. R. Eastwood and Dr. L. S. T. Burrell for their permission to record this case.
A CASE OF B R O N C H I E C T A S I S W R O N G L Y D I A G N O S E D AS P U L M O N A R Y T U B E R C U L O S I S BY Y. G. S H R I K H A N D E ,
B.s., Medical Superintendent, King Edward VII. Sanatorium, Bhowali, India.
S. N. D., male, twenty-oneyears of age.--The patient came to me for consultation with a history of chronic cough of some years' duration. About a couple of months back he spat blood in small quantities o n t w o different occasions. The temperature was normal except during the period of h~emoptysis, when it rose to ioo ° F, Appetite was good and there was practically no loss of weight. He gave a history of bringing up a fair amount of sputum for a few days, after which it stopped completely. The
PLATE XVI
FIG. 3.--FILM ON APRIL 6, I937.
PLATE XVI
FIG. 3.--FILM ON APRIL 6, I937.
CASES
297
Further treatment considered, but fortunately not necessary to attempt to carry out, was the desensitisation of the skin with X-rays in half-pastille doses. However, whether this would have proved practical with the necessity of repeated trauma and the obvious difficulty in repeating desensitisation doses is problematical. M y gratitude is due to Dr. A. Bingham o f the Manchester and Salford Skin Hospital, who saw this case, and to Dr. H, G. Trayer, the Medical Superintendent, for his advice and help on all occasions.
U N U S U A L R E S O L U T I O N OF A T U B E R C U L O U S CAVITY By A. S. H E R I N G T O N ,
B.c .(cAMB.) Assistant Medical Officer, King Edward VII. Sanatorium, Midhurst.
THE particular interest of this case is radiological. It will be seen from the series of X-ray films (Figs. I to 3) that at the time of the earliest film there was a left subclavicular lesion containing a cavity with a fluid level. This cavity became smaller and disappeared; and the final picture shows the lesion as a localised homogeneous shadow o f " ground glass " appearance. No cavity is now visible--nor can it be seen on a film taken with increased penetration. The final appearance, in fact, resembles an Assman's focus: if the films were to be arranged in the reverse order they would exactly represent the process of cavitation in an Assman's focus. That the opposite process may occur seems worthy of record. The following is a brief clinical account of the case: The patient is a single woman, a schoolmistress, aged 53. She had a heakhy childhood, and a healthy adult life until the time of the war, when she became very " run down," and subsequently she has suffered from recurrent attacks of biliousness and " colitis." In 193o , at the age of 46, her condition was investigated at a London hospital, and it is reported that she had " a marked secondary anaemia and hypotonic gastro-intestinal tract," but that " there was nothing to suggest tuberculosis at that time." There is no family history of phthisis; nor can any history of contact be elicited. The first sign of her present illness appears to have occurred in June, I936 , when she had a " gastric attack," which confined her to bed for
298
THE
BRITISH JOURNAL
OF TUBERCULOSIS
five days. This differed from previous bilious attacks in being accompanied by feverishness (temperature Io2 ° to Io3 °) and night sweats, and left her with a slight dry cough. In August, i936 , a similar attack occurred: and in September she became feverish for a third time, when her cough became worse and a little sputum developed. This was examined and found to be negative, but her chest w a s X-rayed and the diagnosis of pulmonary tuberculosis was made. She was in bed for ten days, and then went away for a holiday to Devonshire, where her cough entirely disappeared. In December, i936 , she consulted Dr. S. R. Eastwood, as a result of which she was ordered complete rest in bed. Fig. 2 shows an X-ray of her chest condition at that time. Her sedimentation rate (i hour Westergren) was then Io ram. There was no sputum and the temperature was subnormal. The patient remained on strict rest until she was admitted to the King Edward VII. Sanatorium, Midhurst, on April 2. The cavity had then disappeared (Fig. 3). There were a few fine crepitations in the left subapical region. Her sedimentation rate (½ hour micro method) was 25 ram. After two months, during which time she was slowly advanced in the sanatorium rdgime, her Sedimentation rate dropped to 15 ram., t h e physical signs disappeared and she was able to walk one and a half miles a day without reaction. She has had no cough or sputum and no rise of temperature above normal. The chest lesion would now appear to be stable. I wish to thank Dr. S. R. Eastwood and Dr. L. S. T. Burrell for their permission to record this case.
A CASE OF B R O N C H I E C T A S I S W R O N G L Y D I A G N O S E D AS P U L M O N A R Y T U B E R C U L O S I S BY Y. G. S H R I K H A N D E ,
B.s., Medical Superintendent, King Edward VII. Sanatorium, Bhowali, India.
S. N. D., male, twenty-oneyears of age.--The patient came to me for consultation with a history of chronic cough of some years' duration. About a couple of months back he spat blood in small quantities o n t w o different occasions. The temperature was normal except during the period of h~emoptysis, when it rose to ioo ° F, Appetite was good and there was practically no loss of weight. He gave a history of bringing up a fair amount of sputum for a few days, after which it stopped completely. The
PLATE XVI
FIG. 3.--FILM ON APRIL 6, I937.
PLATE XVI
FIG. 3.--FILM ON APRIL 6, I937.