CASE HISTORY

Patient came of good stock and apart from a little winter cough she had been in good health until two months before admission when she developed a rather severe cough and brought up a fairly large quantity of sputum. She also began to lose weight and in the ensuing two months lost twos tone. Ten days before admission her throat became sore and she became hoarse though she suffered no pain. Her appetite remained good and she never had a haemoptysis. On examination she was pale and emanciated, with a hoarse voice. Enlarged glands were palpable in the right and left submaxillary regions. Both tonsillar fossa were ulcerated. Pulse normal. BP 125/85. Chest shows marked wasting allover. Impaired not all over. Breath sounds diminished on the right with tubular breathing over both sides. Crepitation at both bases. Whispering pectoriloquy at both apices. Heart showed a systolic murmur at both apex and base. Abdomen showed no tenderness or other abnormality. Sputum showed numerous acid-fast bacilli. X-ray of chest showed multilocular cavity in upper zone of right lung with wide spread infiltration of middle zone. Left lung: enormous cavitation of upper and middle zones with pleural thickening and infiltration and softening of the middle zone. Patient was in hospital six days. On the day before death she complained of abdominal pain and was found to be tender.

PATHOLOGY

The specimen consists of the anterior halves of both lungs together with the respiratory passages. At both apices there are extensive cavities. These communicate with the bronchi, the communication being particularly well shown on the right side. In the middle zones of both lungs there is a moderately extensive consolidation by a conglomerate fibro-caseous tubercle. This also extends in the form of more isolated foci into the lower zones. The whole of the trachea and the proximal portions of both major bronchi show tubercular ulceration. This also affects the posterior wall of the pharynx and the right tonsillar fossa. The root glands are enlarged and show pale areas but no definite caseation. On the right side (back of specimen) there is a large pale fleshy lymph gland just below the level of the tonsillar fossa.