Elsevier

Diseases of the Chest

Volume 6, Issue 7, July 1940, Pages 211-214
Diseases of the Chest

Cerebral Air Embolism, Subcutaneous Emphysema, and Spontaneous Pneumothorax in a Tuberculous Patient: Report of an Unusual Case

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Summary

An unusual case of spontaneous pneumothorax, subcutaneous emphysema, and cerebral air embolism is presented. These conditions were not due to any mechanical interference or induced by artificial pneumothorax therapy.

Section snippets

Clinical Abstract

The patient, C. G., a 41 year old male negro prisoner was admitted on March 6, 1939, complaining of:

  • 1.

    Cough

  • 2.

    Loss of weight

  • 3.

    Expectoration

  • 4.

    Hemoptysis

  • 5.

    Weakness.

History of Present Illness: The patient states that he was quite well until September, 1938, when he began to cough, lose weight, and feel weak. The cough persisted, became worse, and productive of white sputum. On occasions, the sputum was bloody. He showed breathlessness on exertion for three months and night sweats for two weeks. He has been

Progress Notes

3/10/39—Therapeutic Conference: Treatment to be bed rest for the time being.

5/4/39—Therapeutic Conference: Advised therapeutic pneumothorax on right.

5/18/39—On three separate occasions artificial pneumothorax attempted, but no pleural space could be found, and therefore was discontinued. Patient was placed on bed rest.

6/19/39—Patient developed a generalized edema of the face, back, penis, and ankles. The abdomen was distended with fluid. The liver was not palpable, there was no venous

Necropsy Report

External Examination: The body is that a moderately well nourished, 41 year old, blass male, of large stature. The skin is emphysematous throughout, with the exception of the of the left arm. The scrotum and penis tremendously emphysematous. The superficial lymph nodes are not palpable.

Internal Examination: The right pleural cavity is partially obliterated by dense fibrous adhesions, the free part contains air and purulent material; the left pleural cavity is free of adhesions. It contains

Pathological Diagnosis

  • 1.

    Marked subcutaneous emphysema over entire body with exception of left arm; pyopneumothorax bilateral, purulent pericarditis and peritonitis; extensive fibrous pleural adhesions.

  • 2.

    Heart: Moderate atrophy.

  • 3.

    Aorta: Apparently normal.

  • 4.

    Lungs: Chronic pulmonary tuberculosis with widespread cavitation in right lung and widespread, chiefly bronchogenic, extension in both lungs; caseous tuberculosis of bronchial lymph nodes.

  • 5.

    Spleen: Tuberculosis; amyloidosis.

  • 6.

    Kidneys: Amyloidosis; lipoid nephrosis;

References (11)

  • BrunsE.H.

    “Air Embolism as a Complication of Artificial Pneumothorax Therapy,”

    Colo. Med.

    (1930)
  • McCurdyT.

    “Air Embolism in Artificial Pneumothorax,”

    Amer. Rev. of Tuber.

    (1934)
  • HamiltonC.E. et al.

    “Air Embolism,”

    J. A. M. A.

    (1935)
  • AndersonD.L.

    “Air Embolism and Pleural Shock,”

    Virg. Med. Monthly

    (1936)
  • HartleyG.S. et al.

    “Air Embolism or Pleural Shock—Report of Two Cases,”

    Virg. Med. Monthly

    (1938)
There are more references available in the full text version of this article.

Cited by (0)

Necropsy by Dr. William Ehrich, Visiting Pathologist at the Philadelphia General Hospital.

Service of Dr. Nathan Blumberg, The Philadelphia General Hospital, Philadelphia, Pa., August, 1939.

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