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Neoplasms and Parasites of the Lungs and Pleura Congenital Anwlalies

frequently, attacks, symptoms, lung and pleuritic

CONGENITAL ANWLALIES, NEOPLASMS AND PARASITES OF THE LUNGS AND PLEURA A congenital lack of development of a lung has been observed sev eral times. The sante is frequently recognized only in autopsy, since the affected side of the chest becomes expanded by vicarious emphysema, and since the development of the sound lung is retarded.

Pulmonary hernias are of rare occurrence, mostly congenital, more rarely following injuries. They arc due to defects of the muscles or ribs in some part of the thorax, in which situation the lung protrudes exter nally in the shape of an elastic, compressible, and reducible swelling, increasing during expiration and producing clear pulmonary resonance. The costal pleura serves as a hernial sae; the overlying slkin is normal in appearance. Retention by means of a bandage often acts beneficially.

Of neoplasms the sarcoma is the most frequently met with, and often occurs secondarily in the lungs, but only rarely primarily in the lungs or pleura. Secondary sarcoma (frequently multiple and central) often progresses without any symptoms. Primary sarcoma of rapid growth may lead to extreme flatness (also with pleuritic effusion), distention of veins in the chest, compression of the large vente cavte, and (edema of the face and the upper extremities, displacement of the heart, etc.

More frequently; than primary, genuine neoplasms but with similar symptoms are seen echinococei of the lungs, in countries where this dis ease is also otherwise observed. Next in frequency to the liver, the echinocoecus disease attacks the lungs (by direct immigration of the embryos or by metabolic inva.sion of a daughter-cyst), or tbe pleural

cavity, by extension from the surface of the liver. The cysts are usually unilobular. The children are usually between six to fourteen years of age.

The symptoms are often for a long time those of an indefinite pul monary or pleuritic affection. Unilateral dulness, most frequently in the region of the right lower lobe, dyspncea, sometimes arching of the chest wall at a circumscribed ,spot, frequent attacks of coughing with muco purulent, bloody expectoration in which remnants of hydatids or books are demonstrable, gradually develop. Intercurrent attacks of fever (pus formation of the cysts) often occur. The course is very slow, and often terminates fatally amid emaciation, bronchopneumonia, etc. Sponta neous recovery is sometimes possible by rupture through the bronchi.

Diagnosis is greatly- facilitated by the presence of echinococcus of the liver; otherwise, simply a pleuritic effusion (which often accompanies it) or 60MC puhnonary affection is assumed to be present. The diagnosis is rendered certain by the characteristic composition of the expectoration, or by the contents of an exploratory puncture (clear, without albumin).

The treatment should not cause suppression of the cough (Roger), since this facilitates the expectoration of the membranes. Opening of tbe cyst by costal resection may often still lead to recovery.