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FILE NAME: Kent (KNT) DATE: 1947 DOC#: KNT111 DOCUMENT DESCRIPTION: Book Excerpt - Diseases of the Chest With Emphasis on X-Ray Diagnosis DISEASES of the CHEST With Emphasis on X-ray Diagnosis By ELI H. RUBIN, M.D., F.A.G.P., F.G.G.P. DCliirneicctaolr oPfroMfeesdsiocrineo,fSMetoendicHinoes,pitNale,wNeYwoYrkorMk;eVdiicsiatlingCoPllheygsei,ciNanewin YChoerkst; DofisPeuaslmeso, nMaoryrriDsaisneiaasCesi,tyMHoonstepfiitoalr,eNHeowspYitoarlka;nAdttCenoduinntgryPhSyasnicaitaonri.uDmi,viNsieown York: Associate Physician in Chest Diseases, Lebanon Hospital, New York. The Principles of Surgical Treatment By M O R R IS R U B IN , M .D ., D .S., F.A .C.S. Clinical Instructor in Surgery. Mew York Medical College, New York; Active Consultant in Thoracic Surgery, Fordham Hospital, New York; Visiting Surgeon, Seton Hospital, New York; Associate Visiting Thoracic Surgeon, Morrisania City and Triboro Hospitals. New York; Adjunct Thoracic Surgeon, Montefiore Hospital, New York. 355 ILLUSTRATIONS WITH U PLA TES IN COLOR W. B. SAUNDERS COMPANY PHILADELPHIA & LONDON Copyright, 1947, by W. B. Saunders Company Copyright under the International Union \ll Rights Reserved Tmhaiys bbeoodkuipslipcraotteedctoerdrbepyrcoodpuycreidg,hitn. Nanoypmaratnonfeirt without written permission from the publisher Reprinted October. 1947. M ay, 1948, and M arch, 1950 MADE IN U. S. A. PRESS OF W. B. SAUNDERS COMPANY PHILADELPHIA tubFeirgc.ul1o7s8is.--inSiltihceotuubpeprecrulloosbies. shRoowenintggegnroagyriasmh-brleavcekalasppneoadrualnacresiolifcolusinsgadnude intocreaasssoedciahteildarandethnrsaictioessi.s;A,ulSceilriactoitviec sntorduuclteusrecson(asissbteinsgtoosfbdoednisees)cowrheischofgfiivberouasptriusssusieansubrlruoeunrdeaecdtiboyn lfaomr iinroante.d(Cwohpoyrlrsigohft,hyCailbinaePfhibaerrms.aBce,uStipcianldlPer-osdhuapcetsd, Inc., Summit, N. J.) 346 DISEASES OF THE LUNGS AND BRONCHI dizierdecetsxttehnesiopnhyisnitcoiaand'sjaactetnetntliuonng tfoieltdhseopftoesn shiabslesuegxgisetsetnecdethofe atedrmust"mdiosdeaifsiee.dPseilnicdoesrigs"rastos caorevenrosteudchinintshteanrcoeesntwgehneoregraabmnoirnmtahlesahbasdeonwces oaftmaodsepfhienrieteohriswtohreyreofexepxopsousruerehtaos abeseinlictioouas m"mixotduirfeiedofsdiluicsotss.isA" ipsrjeussutimfiepdtivoendtihaegnboassiiss ooff pthreovreodenbtygeanddfiintidoinngasl,sttoudbiees.confirmed or dis peScuevliearralepghgyshsieclilancsalhcaivfiecadtiroanwsn oacttceanstiioonnalltoy elunncgosu.nTtehreedseinnothdeuleroseanrtegesnpohgerraomidoifnsislhicaopteic, hthaevmin.gTahneyapmpaayreonctcluyr cwailtchifiinedthceapsianrgenacrhoyumnda otironins hthaevehibleaerngolafnfedrse.dAtoneuxmpblaeirn otfheeixrpplaencua ltihaerycornepfirgeusreanttiocna.lcIitfihedasabreeeans poofsttuublaetrecdultohsaist ginefneecrtaiotinonorinsiliocrotiacronuonddulessiloicrotciaclcinfioedduldees. dRiireemcterinshuaglgaetisotsnthofatcathlceiusmhadaolownsgrwesiuthlt sfirloicma pheartcicitleess. sAtusdaiedsditoinoncaallecviuidmendcuesftorinhhisalbaetiloienf showing analagous Clinical Feature sr.o--enAtgdeinagsnhoasdioswosf. silicosis cpahnynsioctalbefinmdaindgesoanlothnee,baalsthisooufgshytmhpetoprmesseanncde onfititehse wcohnedreitisoinlicmosaiys ibsepsruesvpaelcetnetd. iAn cdoemtaimleud oincdciusppaetnisoanballe.hiWstohrayt amnadyasreoeemnttgoenaongirnadmivaidre uwaals aentgraivgieadl ioncciutpmataionny, ypeaarrtsicubleafrolrye, ifmahye plurnogveintojubrye. imOnpotrhteanotthaserahpaonsdsi,blae msoaunrcwehoof mhaasyspneontthmavaenycoynetararscteind aa mduinsitngdisineadsues.trAy rmeacnenotfetxwpeenriteyn-nceinewacsamqeuittoe milelufmorinaatrionugt.inAe ctoheshtaevxeamadinvaatniocnedbepcuaulmseonhaisrywifteubwearcsufloousnisd. Ttuhaetioronenotfgetnhoeghraimlarremvaerakleindgms oadnedraltieneaacrc,enin pbloatcheslunnogdsu,lacrh,iedfelynstihtieesriinghtht e(Fmigid.p1o8r5ti)o.nTshoef asupgpgeeasrtantucbeerocuflotshies. Troheentpgaetnieongtr'asmoccduipdatinoont aOtnthcleosmeromqueensttiwonaisngth, ahtoowfeavefrr,uiitt wmaesrcfhoaunntd. thhaadt wfoorrkalemdoosnt tshhriepesyaesaarsn, edluercitnrgictahrecwwaerl,dheer onfizsetdeesltepelaltwesi.thPaarctooaftitnhge otifmzeinhceaunsdedthgealrvesat oAflththoeugthimhee hbaldacskomireonprowteitchtioount aagacinosattinthge. fcuhmanegse, sitwseereemdedue liktoelyinthhaalattiothne orfoenmtgeteanl finujmuerys,. a recognized source of pulmonary cepTthibeilpitaysttohisintoferyctimonasyorfevtheael uinpcpreerasreedspsiuras t"oarsythtmraac.t", Tphleeuirnisiyti,alresctaugrreisnogfpsnimeupmleosniliiacsosoisr suenladcocmoucnatuasbelesidgynsipfinceaantwshyimchpitsoomust eoxfcperpotpoforr tliuonngtointvhoelveexmteenntt,ofththeeddyissepanseea. Wbeicthomgeresatienr ccoreuagshin, galtyfsiresvtedrerya,nldatiesr sporoonduacstsiovcei,attehde wspituh tmuamy hoaftveenamfeixeleidngwoifthtigbhlotnoeds.sTinhetheincdhiveisdt,uaatl atinmdevsaogfuaepaabidnofumlinnaatlucroem. Ipnlcarienatssianrge wfreeaqkuneensts. Sadildiciotisoisn, wbyithabuinnfdecatniot nexpisecctohraartaicotne,riaztetdi,meins florassnkofhwemeigohptt.yAsislt,hfoeuvgerh, dswysepantienagaannddcmyaanrokseids mresaty, boertehvoipdneenat eisvennotwsheeenn tuhneleisnsdtihveidreuailsiaslsaot ctearrfdeiraecncienswufifthicitehneclyescsaeursceidrcublyatiinocnr.eEasnignogrgine mtheenltivoefrthaendvesinpsreianditnhge needcekm, aenalaprpgeeamr elnatteorf. Tfahileurfeewarwe haoptestcoapesutcucbuemrcbultoosisinoterrccuarrdreianct pnSeuemveoranliao.bservers have found a greater in cthidaenncaemoofngcanrcoinnsoilmicaotoicfs.thTehleunrogleinplsaiyliecdotibcys sdioliucobstisthiant acarrceilnaotigoennsehsiips eixsisotbssbcuetrwe.eeMn atnhye atwscor,ibtehdeitro pargees,ensceex ianndthoethsearmfeacltuonrsg wbheiinchg favTohrethpehydseivcaellofpinmdeinngtsofarcearncointoimlluam. inating. Saniliicnodsiisviodfuaadlvwahnoceadppdeegarresewmelalynobuerpisrheesdenatnidn irnevtehaelsbesetviodfehnecaeltho.fExemamphinyasteiomna.of Tthheercehesist dsiiomni,nitshheedexcpoisrtaatlorayndphdaisaephersapgemciaatlilcy ebxeciunrg pTrhoelroengisedu.suTahlleyfhinygpeerrtriepssonmaanyceshoonwpecrlucubsbsiinogn. 348 DISEASES OF THE LU SO S AND BRONCHI orofeinntcgiepnieenxtasmtaigneastioofnsthfeacdiilsietaatsee.the detection preAsesntcreikionfg"faesabteusrteosofbotdhieesp"atsheoelnogoyn ihsistthoe ASBESTOSIS yloeglliocwexoarmbinroatwionn boofdliuensghtaisvseueb.eTenhessheogwonldbeny inAcsobmesbtionsaitsioanhywdirtahtedtrascileicsatoefofirmona,gnneiscikueml, Gaslboeysntoestofibbeers,cocmopvoesreedd obfy aacleanyterarlocforierono-f cmailnceiudmin amndanyalpuamritnsuomf.thTehweorsldu,bsintacnlucdeinigs criovnetdaifnroinmg bmloaotedripailgmwhenicthoifstbheeliteisvseudesto. Absebdees C(cahnryadsoat,ilwe)hiesreobmtaoinstedo.f MthieneAdmasebriecsatnosscuopmpelys atossbebstoodsiews omrkaeyrs,bbeuftotuhnedir ipnretsheencsepduotuesmnootf isnpulnonogr, wthoivne,n.fibIrtosupslisatbrlaendtesxtwuhreichancdanhigbhe neTcehsesarroileyntignednicaaptepelaurnagncdeisoeafseea.rly asbestosis arensiismtapnocretatontheinadtuasntdricahl epmroicdaulcstminakteheasmbeasntous disisntointgruevisehailninggc.hAardavcatnerciesdticdsis.eTahseeofifnteenpsuhlmowos finagctmuraeteorfiaml,aettlreecstsriecsa,lbirnaskuela-ltiinoinn,gi,nfjiarec-kpertoionfg npahryysefmibaroasinsd, poavtecrhlyyinargeapsleoufriintitserasrpeerrseefldecetmed bbuoiilledrisnganfdixtsutreeasm. Apilptheosu, gahndthien dauvstariheatzyarodf aronecnetgoefnaoluogniicfoarllmy iqnuaa"ligtyro, uinndp-glalacsess"sahpopweianrg ansesaorclyiacteodmwpaitrhe tihneparesbveasletonsceinwduitshtrtyhadtoeosf nthoet dsuemnseerthoepancoitdieuslawtiohnicho,fhsoiwliceovseirs, (sFelidgos.m18a3s, spiulitcsaaisnbdeusstotrsyis, tahmeornagpitdhegriomwptohrotafntthefofromrms oefr c1h8i4e)f.lyThinevololvweedr. pAortimonasrkeodf thpleeulruanlgsreaarce duIsnthdailseedasaessb. estos fibers range in size from 10 tcioosntopmharennifiecstssiniutsseelsf, iann oubnleivteernantieosns ooff tthhee ltuon2g0s0ismmieccrohnasniocralmraotrhee. rTthheainr cahcetimonicaoln. Tthhee daniacpehraatgtmheanpderaipfehleteryd oorf"tphoerccuapridniea"caspiplheoaur lloardggee pinartthicelelsu,muennabanled toobsetnrutecrt tthhee raelsvpeiorlai, eadtthee,siothnes. last caused by pleuropericardial otoliryisbrfoonllcohwioeldesb. yAtaelefcibtarsoitsicofrtehaectdioisntalinaltvhee graTdhuealonisnectreoafsetheindisceoausgehi,s ienxspideicotoursatwioitnh, cgoollacposmedpetnisssauteo.ryXoenmopbhstyrsuecmtead. aClvoeonltiraurnydetro dtoyswpnoreka., Tlohses opfhwyseiicgahlteaxnadm, iinnattiimone,isinnaobtilirtey tnhoadtulsaeteionninunsilleiscsosissi,licthaeries ims ipxreadctiwcaitlhly thnoe vpeeacluinliga.r WeaorothdyancdomGploleyxnieondroafwthaettefanctieoanntdo aa amsubcehstoesnldaurgste.dTfhoer hthilearrelyamsopnhtnhoadtesthaerelynmot ssolimghet,invdiiovliedtuatilnsg. eOcincasthioenaclhlyee, kassbaensdtoslicposrnosf lpohgaicticpsroacreessn.ot actively engaged in the patho opcecnuertriantiothneosfkaisnbpefstothsefihbaenrsdsinctoautsheedsbuypetrhfie terTizheedgbroyssscaaptpteeraerdanacreeaosf tohfedliufnfugseisfcibhraorsaics, ctwiaeleenpifdiveermtois.teInt tyaekaerss, foonr athsbeesatvoesriasgteo, bdee oafffethcetinugnicnhvioefllvyedthpearlotswaenr dloibnetse,nesempphleyusreitmisa. cvoelnotpa.ctWishebthroekretnhewdiitsheaassebceastnosprdougrsetssisasfttielrl cDoespiseannddinsgiloicnostihse, tehxetreenatroefacsoseoxciisattiendgcahnatnhgraes- unonnsetuttbleedrc.uDloeuasthinrefesuctlitosnf,romcontguebsetricvuelouhseaortr annoddesp.igInmfeecnttiaotniownitohfptyhoegelnuincgosrgaanndismlysmanpdh dmiseeaassueresorlisotethderforinttheercpurrerveennttidoinseoafsessi.licTohsies ctuubloesricslehabsacbileleinmfooduinfyd tihneapbaothuotloognye-.thTiurdbeorf apSpelyvearlaslo otothaesrbseisltiocsaitse.s have been reported tahsetaoutwophseitehdercaassebse, sbtoustisthpeerer issesofamveordsouthbet wtohicchauisseuspendeeuxmteonnsoivceolnyioinsisb.leaFcuhlilnergsf'atesaartnhd, dneevraebloilpitmyentot oftutbuebrecrucluolsoissis,isorprwimheatrhileyr vduule cohilas,ngehsasin btheeenlunfgosunwdithtosymcaputosemspsaitmhoillaorgtioc ftoactoproso.r working conditions and incidental tchaotesecsoemenpoiunndsi,licuosseids. iBnetrhyelliummanduufasct,tuaresiloif OCCUPATIONAL HAZARDS INVOLVING THE LUNGS 349 Fig. 183.--Asbestosis in a man of 31 exposed to asbestos dust for five years. Roentgenogram reveals fine reticular infiltrations affecting chiefiy the lower portions of the lungs. (Courtesy, Dr. E. P. Pendergrass, Hospital of the Univer sity of Pennsylvania. Philadelphia, Pa.) forFtihg.ir1ty84y.--eaArss.bFeostuorstieseinn faellmowanwoofr.k53erws hdoiedwoorfkaesdbefsotroasins.aRsboeesntotgsecnoomgrpaamnyrepvaeratlstinmoedufolarreaignhdtdyeenasres, adnifdfufsuelllitnimeaer infiltrations involving both lungs with intervening emphysema. (Courtesy, Dr. E. P. Pendergrass, Hospital of the University of Pennsylvania, Philadelphia, Pa.)