23568              PNEUMONIA

The patient, a woman aged 76 years, was admitted to hospital after having been found unconscious.  She responded to painful stimuli using both sides of the body, but did not make any spontaneous movements.  All limbs were hypertonic and both plantar responses were extensor.  The respiratory rate was 32 per minute, deep and sighing with a prolonged expiratory phase.  The pulse rate was 104 and the blood pressure 85/50.  Her condition steadily deteriorated and she died a fortnight later.  The brain showed an intra-cerebral haemorrhage.

The specimen consists of a portion of the left lung, showing confluent grey consolidation in the posterior segment of the upper lobe.  In addition there is confluent and patchy haemorrhagic consolidation in the apical and posterior segments of the lower lobe.  The remainder of the lung shows emphysema with stellate interlobular patches of fibrosis in the upper lobe and congestion in the lower lobe.  Histology shows diffuse pneumonic consolidation which is rather variable.  In some places there is dense fibrinous and polymorphonuclear exudate, and in others there is much coagulated fibrinous fluid with scanty cells.