Diseases of the chest and the principles of physical diagnosis . tably scarlet fever, the conditionis not infrequently met with. Empyema may arise also as the result ofpenetrating wounds of the chest wall or as the result of disease involvingthe mediastinum. Morbid Anatomy.—In pneumococcic empyemata the effusion consistsof a thick creamy pus having a sweetish odor. When allowed to standthe fluid separates into a clear, greenish j^ellow, upper layer, the cellular DISEASES OF THE PLEURA 591 elements sinking to the bottom. When due to the streptococcus thefluid may be only turbid in appearance. A
Diseases of the chest and the principles of physical diagnosis . tably scarlet fever, the conditionis not infrequently met with. Empyema may arise also as the result ofpenetrating wounds of the chest wall or as the result of disease involvingthe mediastinum. Morbid Anatomy.—In pneumococcic empyemata the effusion consistsof a thick creamy pus having a sweetish odor. When allowed to standthe fluid separates into a clear, greenish j^ellow, upper layer, the cellular DISEASES OF THE PLEURA 591 elements sinking to the bottom. When due to the streptococcus thefluid may be only turbid in appearance. An empyema is most apt to develop as the result of an extensivefibrinous exudate such as occurs in pneumonia where the membrane isthick and presents a shaggy appearance. In tuberculous cases theeffusion may be changed from a serous to a purulent one as the result ofinfection from the lung. The effusion maj^ be massive, filHng theentire pleural sac (see Figs. 344 and 345), or it may occupy but a portionthereof. Encapsulated effusions are considered Fig. 345.—^lassive left-sided empjema occupying practically the whole pleuralcavity. The lung is represented by two small fibrous masses adherent to the pericardiumwhich contains a small serous effusion. The heart, which is enlarged, is filled with bloodclot. The diaphragm is pushed downward and the right lung greatly iCompressed.(Pirogoff.) Unless the purulent material is removed within a short time from itsonset the lower portion of the lung in contact with the fluid becomesfirmly adherent to the chest wall and mediastinum. The adhesions be-come organized very quickly and the lung is thus firmly anchored andprevented from reexpanding even when the fluid is removed. The longerthe purulent material is allowed to remain the more certain it becomesthat the lung cannot be reexpanded. If the empyema has existed forseveral months the parietal pleura forming the sac becomes greatlj^ thick-ened and in places may become eroded
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
