CASE HISTORY

This patient had had winter cough with copious sputum for at least 10 years. Within the last year this had got worse and he had had occasional haemoptysis. About a week before admission in Feb 1960 he had an exacerbation of his cough and sputum. He was brought into hospital unconscious, cyanosed and almost moribund and in spite of treatment he died within a few hours. At autopsy the only findings apart from the lungs was ventricular hypertrophy, the right ventricle being 8mm thick instead of the normal 3mm.

PATHOLOGY

The specimen consists of a sagittal slice of the right lung viewed from the outer side. In the upper lobe most of the pulmonary structures is preserved. The air spaces are uniformly dilated and in addition there is local emphysema immediately posterior to the extreme apex and about the middle of the anterior fringe of the upper lobe. In the lower lobe there is also some emphysema but it is slight and very largely masked by extensive bronchopneumonia that causes the lung to look a greyish-buff colour. In the upper lobe the bronchi quite often have a rather bright pink colour suggesting vascular congestion. In the lower lobe, in addition to this, many of the bronchi show a frankly purulent exudate in the lumen, sometimes almost occluding it. Viewed from the back of the specimen the lung is breaking down and forming an abscess with haemorrhage in the posterior costophrenic angle. Essentially the same emphysema and pneumonia is seen as on the other side but in the upper lobe where some of the bronchi are cut longitudinally it is possible to recognise dilation in them. In addition, near the anterior fringe of the apical part of the upper lobe there is an area of old scarring. Note that the middle lobe is collapsed and pinched between the upper and lower lobes in this particular plane of section.