16340              CHRONIC PULMONARY TUBERCULOSIS

The patient was a man aged 49 who presented for the first time only a week before his death, with a 6 month history of weakness, loss of weight, sweats and productive cough.  He had been off work and ill but did not see a doctor for the previous 8 months.  Over the last 4 weeks he lost his appetite and wasted rapidly, and became confused and disorientated during the last 3 days.  The sputum culture produced numerous acid-fast bacilli and he was transferred from the Q.E.H. to the R.A.H. febrile and moribund, with rapid shallow breathing, cyanosis, gross wasting, dehydration and X-ray evidence of extensive pulmonary tuberculosis.  He died on the following day.  At postmortem bilateral pulmonary tuberculosis was found together with a tuberculous focus in the right kidney.

The specimen consists of the sectioned right lung.  There is chronic ulcero-cavernous tuberculous disease at the apex, and in the apico-posterior segment of the upper lobe, where large cavities are present with walls lined by shaggy exudate and with a good deal of surrounding fibrosis.  There is marked overlying pleural thickening and fibrous adhesion.  Fibrosis has spread irregularly through the remainder of the upper lobe where some bronchiectasis is present.  The middle lobe is free of disease except for one small soft caseous focus at its upper border.  There is marked acute confluent caseous bronchopneumonia in the anterior basal segment of the lower lobe.  There is some acute pleurisy overlying the lateral aspect of the lower lobe.