23727              ORGANISING CONFLUENT BRONCHOPNEUMONIA

The patient was a man aged 67 who collapsed while playing indoor bowls.  He felt weak and hot, sweated and coughed up a small amount of bloodstained sputum.  On examination there were crepitations in both lung bases but no other significant findings.  Barium meal in hospital showed a polypoid carcinoma in the fundus of the stomach which was resected at a partial gastrectomy which was performed through a thoraco-abdominal incision.  Post-operatively he had what was described as cardiac and renal failure secondary to bronchopneumonia.  Intensive resuscitation, antibiotic therapy and tracheostomy produced a temporary improvement but gram negative bacilli were cultured from the blood and he died 35 days after admission and 20 days after the operation.  At postmortem there was gross fat necrosis in the peritoneum, pancreatitis and ascites.

The specimen consists of the right lung sectioned to show confluent pneumonic consolidation, partly red and partly grey, throughout the entire lung field.  The overlying pleura is a little dull.  Histology shows diffuse pneumonic consolidation with scattered focal haemorrhages.  Much of the tissue shows young fibroblastic granulations filling the alveoli.