20469              MULTIPLE LUNG ABSCESSES

This patient was a woman aged 78 with a history of repeated lung infections for several years with recent increase in dyspnoea.  She was admitted with evidence of basal pneumonia.  The chest expansion was poor, the trachea was deviated to the right, there was dullness to percussion and bronchial breathing at both bases with coarse crepitations.  Treatment with penicillin was begun.  A few days later she fell out of bed and fractured her left hip.  At this stage she was transferred to the R.A.H. but died a week later.

The specimen is the left lung sectioned to show several areas of fibrosis with abscess formation.  There is a wedge shaped area at the apex, a larger area at the tip of the lingular segment of the upper lobe where bronchial communication with the abscess is evident, suggesting a bronchiectatic origin.  A further area of abscess formation is present in the apical segment of the lower lobe.  These lesions appear of some duration.  There is more acute septic bronchopneumonia in two regions at the base of the lower lobe.  Well marked fibrinous pleurisy overlies the posterior surface of the lower lobe.  Histology shows fibrosis with suppuration and cavitation.