Thirty eight patients with chronic sputum expectoration underwent indium-ill labelled granulocyte lung scanning and measurement of whole body loss of indium-ill labelled granulocytes. Twenty four patients had radiologically proved bronchiectasis and 14 had mucus hypersecretion without radiological evidence of bronchiectasis. None was having an acute exacerbation at the time of the scan. The median 24 hour volume of sputum expectorated was 17 (range 2-175) ml. The 24 hour volume of purulent sputum was 5 (0-142) ml; six patients expectorated mucoid sputum only. Twenty one of the 38 patients had a positive granulocyte lung scan. All nine patients expectorating more than 20 ml purulent sputum in 24 hours had positive lung scans and all had lost more than 19% of the indium-ill from the body after five to seven days. Of the six patients with mucoid sputum, only one had a positive scan and these subjects lost only 6-11% of the indium-III in five to seven days. The percentage loss of indium-ill from the body correlated with 24 hour purulent sputum volume (r = 0-41, n = 38, p < 0 001) and total elastolytic activity in 24 hour sputum (r = 0-54, n = 14, p < 001).
Summary:Two patients with lymphoedema of the legs developed recurrent respiratory infections and were found to have panhypogammaglobulinaemia. The early recognition and treatment of this form of immunity deficiency in patients with lymphoedema is important in order to prevent recurrent infections which could cause pulmonary damage and further lymphatic stasis.
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