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Since its first description, by Leblond1 in 1824, rupture of caseous lymph nodes into air passages has received much attention in the literature (summaries by Barthez and Rilliet,2 Ebert3 and Scobie4). Most of the reports deal with children in apparent good health who are suddenly seized with severe paroxysms of coughing, become deeply cyanotic and die shortly after the onset of the attack. There are a number of striking differences between these cases and my own.In the course of routine autopsies on 1,656 tuberculous persons I observed perforations into the trachea and the bronchi 22 (1.3 per cent) times. I cannot consider this a true incidence because I do not know how often a progressive cavity develops at the site of an intrapulmonary perforation, the subsequent disease obliterating all signs of the rupture. AGEThe youngest person in my series was 1I/2 years of age; the oldest, 57 years. The fact that the majority of patients (12) were more than 21 years of age is in contrast to the distribution given in the majority of reports, namely, that the perforations occurred chiefly in children. The reason for this conclusion lies in the fact that almost all patients described were children who had begun to suffocate and were quickly rushed to a general hospital. On the other hand, in an institution for tuberculous patients where adults predominate, the perforation develops usually in the course of progressive tuberculosis. RACEFrom the table it may be seen that 16 patients were Negroes. This fact is in contrast to the racial distribution in my complete autopsy series, in which the proportion of Negroes to white per¬ sons is 4: 7. In a previous study 5 I pointed out that perforation of tuberculous "cold abscesses" into the neighboring structures likewise occurs far more frequently in Negroes than in white persons. NUMBER AND SITE OF PERFORATIONSIn 13 of 22 cases a single rupture occurred, and in 9 instances 2 or more perforations were present. The presence of multiple perforations is not surprising, since in most cases there was a progressive caseous tuberculosis of the lym¬ phatic system with a tendency to liquefaction of all lymph nodes. The multiple perforations took place not only in multiple areas of the air pas¬ sages but also into the gastrointestinal tract, par¬ ticularly into the esophagus. The largest and most numerous ruptures were seen in 1 case in which perforations were present in the trachea, the right main bronchus, the esophagus, the stomach and the duodenum-twelve openings in all.The table reveals that perforations occur much more frequent into extrapulmonary than into intrapulmonary air passages. The distribution was fairly evenly divided between the trachea and the right and left main bronchi. The openings in almost all instances were located in the lower part of the trachea or in the upper part of the main bronchi. Thus the perforations occurred mainly in the region of the carina. Our findings do not bear out the conception of Paunz,6 that the rupture occurs mainly on the right side, or that of E...
Since its first description, by Leblond1 in 1824, rupture of caseous lymph nodes into air passages has received much attention in the literature (summaries by Barthez and Rilliet,2 Ebert3 and Scobie4). Most of the reports deal with children in apparent good health who are suddenly seized with severe paroxysms of coughing, become deeply cyanotic and die shortly after the onset of the attack. There are a number of striking differences between these cases and my own.In the course of routine autopsies on 1,656 tuberculous persons I observed perforations into the trachea and the bronchi 22 (1.3 per cent) times. I cannot consider this a true incidence because I do not know how often a progressive cavity develops at the site of an intrapulmonary perforation, the subsequent disease obliterating all signs of the rupture. AGEThe youngest person in my series was 1I/2 years of age; the oldest, 57 years. The fact that the majority of patients (12) were more than 21 years of age is in contrast to the distribution given in the majority of reports, namely, that the perforations occurred chiefly in children. The reason for this conclusion lies in the fact that almost all patients described were children who had begun to suffocate and were quickly rushed to a general hospital. On the other hand, in an institution for tuberculous patients where adults predominate, the perforation develops usually in the course of progressive tuberculosis. RACEFrom the table it may be seen that 16 patients were Negroes. This fact is in contrast to the racial distribution in my complete autopsy series, in which the proportion of Negroes to white per¬ sons is 4: 7. In a previous study 5 I pointed out that perforation of tuberculous "cold abscesses" into the neighboring structures likewise occurs far more frequently in Negroes than in white persons. NUMBER AND SITE OF PERFORATIONSIn 13 of 22 cases a single rupture occurred, and in 9 instances 2 or more perforations were present. The presence of multiple perforations is not surprising, since in most cases there was a progressive caseous tuberculosis of the lym¬ phatic system with a tendency to liquefaction of all lymph nodes. The multiple perforations took place not only in multiple areas of the air pas¬ sages but also into the gastrointestinal tract, par¬ ticularly into the esophagus. The largest and most numerous ruptures were seen in 1 case in which perforations were present in the trachea, the right main bronchus, the esophagus, the stomach and the duodenum-twelve openings in all.The table reveals that perforations occur much more frequent into extrapulmonary than into intrapulmonary air passages. The distribution was fairly evenly divided between the trachea and the right and left main bronchi. The openings in almost all instances were located in the lower part of the trachea or in the upper part of the main bronchi. Thus the perforations occurred mainly in the region of the carina. Our findings do not bear out the conception of Paunz,6 that the rupture occurs mainly on the right side, or that of E...
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