Atelectasis and Bronchiectasis in Children

Abstract

Clinical and necropsy observations in relatively advanced cases have been the basis for the many theories regarding the development of bronchiectasis. Little has been known about its pathogenesis. No prebronchiectatic conditions have been recognized, and no serial biopsies have been recorded to show the changes from one period to another. Even if advisable, serial biopsies would most likely not reveal a true picture after the first tissue was removed. If, on the other hand, a large series of children with bronchiectasis were found to show a common, almost characteristic appearance in roentgenograms of the chest during the early period of clinical symptoms, a means would be at hand for the recognition of the onset of a bronchiectatic process, possibly before the actual dilatations of the bronchi had occurred. The pathologic changes in the cases that came to necropsy soon after the presence of this sign and subsequent roentgen observations in the patients who lived would reveal much about the development of bronchiectasis. It has been my privilege to make a study of an unusually large series of children presenting a certain triangular shadow at the base of the lung in pulmonary roentgenograms. This shadow has come to be regarded as representing a change in the pulmonary tissue in which, under certain conditions, bronchiectasis develops. In the early roent¬ genograms of more than fifty children with proved bronchial dilatations, this shadow was found to be present within a few hours or days after the onset of the first symptoms.

Pulmonary Collapse in Pertussis

“…In 1926 Singer and Graham noted that these shadows were often associated with bronchiectasis, and at operation they found that the lower lobes were collapsed. This has been confirmed by Warner (1935), Warner and Graham (1933), Ogilvie (1941), Riggins (1941), Findlay (1935), Anspach (1934), and Andrus (1940), and it has been observed that in these cases the distal small bronchi are often plugged with sputum (Anspach, 1939;Warner and Graham, 1933). Triangular basal shadows were noted in 6 per cent.…”

“…Wall and Hoyle (1932) described cases of dry bronchiectasis which they thought were due to the dilating force of inspiration when the small bronchi were blocked. Anspach (1934) states that the longer the duration of the collapse the more likely is bronchiectasis to develop. Ellis (1933) describes the sequence as collapse then dilatation, and Miller (1934) quotes Schneider (1927) as saying that bronchiectasis is preceded by a purely dilated state in which there is a simple atrophy of the wall.…”

Bronchiectasis in Children: Its Multiple Clinical and Pathological Aspects

“…The common association of bronchiectasis and collapse both clinically and pathologically in humans, and experimentally in animals led to the assumption that pulmonary collapse was the major factor causing bronchiectasis. Warner and Graham (1933), Anspach (1934). Lee Lander and Davidson (1938), Fleischner (1940), Brennemann (1943, Lee Lander (1946) and Coope (1948) have all expressed this view.…”

Lower Lung Field Tuberculosis

“…Most of the reports on basal tuberculosis became available only after 1920 (Feber, 1931;Dufault, 1932;Anspatch, 1934;Hamilton and Freed, 1935;Reisner, 1935;Gorden, 1936;Viswanathan, 1936;Busley, 1939;Sokoloff, 1940;Andosca and Foley. 1943;Ossen, 1944;Romendic et al, 1944;Dock, 1946;Ostrum and Saber, 1949;Fries, 1955;Johnson, 1959;Segarra et al, 1963;Tripathv and Nanda, 1970;Mathur et al, 1974).…”