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PLATES LXXVTTI-LXXX)SECROTIC lesions in the arterial walls in the lungs have been described most frequently in the condition known as " polyarteritis nodosa ".Involvement of lung vessels in this condition, however, was thought to be uncommon. Brenner (1935), in his extensive study of the pathology of the pulmonary circulation, was not convinced of their occurrence in a severe form and, more recently, Smith (1948) was reluctant to consider as an example of polyarteritis nodosa a case with symptoms of asthma in which acute arterial necrosis was found in the lungs as well as in other organs. However, many cases with lung lesions have now been reported, and t,he incidence of pulmonaryartery involvement) is probably in the region of 30 per cent. (Spiegel, 1936).On the other hand, acute arterial necrosis confined to the lung vessels is rare, extensive changes of this kind not having been described until 1950, when Old and Russell observed severe arterial necrosis in a case of congenital heart disease of the Eisenmenger-complex type. A similar case was reported in 1951 by Kipkie and Johnson. McKeown (1952) noted four cases in patients with right heart failure of uncertain origin and Symmers (1952) two cases, one of which was associated with mitral stenosis, as was the case described by Desclin and Gepts (1952, quoted by Symmers). The present paper records a case with numerous interesting features, including acute arterial lesions confined to the lungs, in a patient with mitral stenosis. The mechanism of production of this change is discussed, not only in relation to the lung lesions, but also to the more general problem of the development of similar arterial lesions elsewhere in the body. Case report Clinical historyThe patient, a male aged 31 years, had a long history of rheumatic fever beginning in childhood. In recent years he had experienced numerous attacks of cardiac failure. A well-developed mitral stenosis was present, but he was considered unsuitable for valvulotomy. His final admission to hospital with gross cardiac failure was associated with jaundice. For two weeks before admission he had had a cough with sputum and some joint pains. An antistreptolysin titre of 1 in 250 indicated recent infection with 6-haemolytic J. PATH. BACT.-VOL. LXV (1953) 333Arch. I r z t . Med., liv, 170.
PLATES LXXVTTI-LXXX)SECROTIC lesions in the arterial walls in the lungs have been described most frequently in the condition known as " polyarteritis nodosa ".Involvement of lung vessels in this condition, however, was thought to be uncommon. Brenner (1935), in his extensive study of the pathology of the pulmonary circulation, was not convinced of their occurrence in a severe form and, more recently, Smith (1948) was reluctant to consider as an example of polyarteritis nodosa a case with symptoms of asthma in which acute arterial necrosis was found in the lungs as well as in other organs. However, many cases with lung lesions have now been reported, and t,he incidence of pulmonaryartery involvement) is probably in the region of 30 per cent. (Spiegel, 1936).On the other hand, acute arterial necrosis confined to the lung vessels is rare, extensive changes of this kind not having been described until 1950, when Old and Russell observed severe arterial necrosis in a case of congenital heart disease of the Eisenmenger-complex type. A similar case was reported in 1951 by Kipkie and Johnson. McKeown (1952) noted four cases in patients with right heart failure of uncertain origin and Symmers (1952) two cases, one of which was associated with mitral stenosis, as was the case described by Desclin and Gepts (1952, quoted by Symmers). The present paper records a case with numerous interesting features, including acute arterial lesions confined to the lungs, in a patient with mitral stenosis. The mechanism of production of this change is discussed, not only in relation to the lung lesions, but also to the more general problem of the development of similar arterial lesions elsewhere in the body. Case report Clinical historyThe patient, a male aged 31 years, had a long history of rheumatic fever beginning in childhood. In recent years he had experienced numerous attacks of cardiac failure. A well-developed mitral stenosis was present, but he was considered unsuitable for valvulotomy. His final admission to hospital with gross cardiac failure was associated with jaundice. For two weeks before admission he had had a cough with sputum and some joint pains. An antistreptolysin titre of 1 in 250 indicated recent infection with 6-haemolytic J. PATH. BACT.-VOL. LXV (1953) 333Arch. I r z t . Med., liv, 170.
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