The Changing Pattern of Pulmonary Suppuration: Surgical Implications THOMAS B. FERGUSON, M.D., F.C.C.P., THOMAS H. BURFORD, M.D.  Diseases of the Chest  Volume 53, Issue 4, Pages 396-406 (April 1968) DOI: 10.1378/chest.53.4.396 Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 1 Bilateral saccular bronchiectasis characteristic of the preantibiotic era. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 2 Bronchogram typical of present-day “surgical” bronchiectasis. Bronchogram of the right lung was normal. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 3 Symptomatic bronchiectasis caused by distortion of the lingula following resection of left lower lobe. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 4 Bronchial compressive disease of the right middle lobe showing narrowing of the lumen by a large calcified node. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 5 Right middle lobe pneumonitis and atelectasis secondary to poor drainage. The bronchus is pushed downward by an adjacent node, but the bronchial lumen is not decreased in diameter. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 6 Bronchial compressive disease in the right lower lobe. The offending calcified node is clearly seen. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 7 Bronchial compressive disease of the lingular segment of the left upper lobe. A “middle lobe syndrome” on the left side. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 8 Preantibiotic lung abscess involving the left upper lobe with contralateral seeding to the right lower lobe. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 9 Right lower lobe abscess typical of intrapulmonary sequestration of the lung. An anomalous systemic artery entered the right lower lobe from the abdominal aorta. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 10 Severe aspiration pneumonia due to a vascular ring. This 11-year-old child had pulmonary symptoms virtually all of her life. She exhibited growth failure and was markedly underweight. She had been evaluated in the past for mucoviscidosis, bronchiectasis and collagen disease before the cause of her difficulty was discovered. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 11 Diagnostic studies obtained in the patient shown in Fig 10 prior to surgery. A. Posteroanterior arteriogram showing a right descending aortic arch and the aberrant left subclavian artery. The first portion of this vessel distal to its origin is flattened where it crosses the esophagus. B. Posteroanterior esophagogram showing oblique indentation in the barium column at the level of the anomalous vessel. C. Lateral esophagogram showing a posterior compression of the barium column due to the aberrant artery. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 11 Diagnostic studies obtained in the patient shown in Fig 10 prior to surgery. A. Posteroanterior arteriogram showing a right descending aortic arch and the aberrant left subclavian artery. The first portion of this vessel distal to its origin is flattened where it crosses the esophagus. B. Posteroanterior esophagogram showing oblique indentation in the barium column at the level of the anomalous vessel. C. Lateral esophagogram showing a posterior compression of the barium column due to the aberrant artery. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 11 Diagnostic studies obtained in the patient shown in Fig 10 prior to surgery. A. Posteroanterior arteriogram showing a right descending aortic arch and the aberrant left subclavian artery. The first portion of this vessel distal to its origin is flattened where it crosses the esophagus. B. Posteroanterior esophagogram showing oblique indentation in the barium column at the level of the anomalous vessel. C. Lateral esophagogram showing a posterior compression of the barium column due to the aberrant artery. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 12 Representative x-ray films early in the course of a patient with “benign” allergic granulomatosis. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 13 Recent x-ray films of the patient shown in Fig 12. At present the patient is totally asymptomatic with lesions known to be present for 18 years. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 14 A. A 24-year-old colored man with ischemic leg ulcers and no pulmonary symptoms. Clinical diagnosis at this time was emphysematous bulla. B. Film taken just prior to emergency pneumonectomy. Cavity is partially filled with fresh blood clot. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 14 A. A 24-year-old colored man with ischemic leg ulcers and no pulmonary symptoms. Clinical diagnosis at this time was emphysematous bulla. B. Film taken just prior to emergency pneumonectomy. Cavity is partially filled with fresh blood clot. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 15 A. Large abscess with almost total destruction of the left lower lobe which developed within a period of two weeks. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 15 A. Large abscess with almost total destruction of the left lower lobe which developed within a period of two weeks. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions

FIGURE 16 Cut surface of the right lower lobe from the case shown in Fig 15 showing the ischemic infarct characteristic of allergic granuloma. Diseases of the Chest 1968 53, 396-406DOI: (10.1378/chest.53.4.396) Copyright © 1968 The American College of Chest Physicians Terms and Conditions