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Stenoss of the Trachea and of the Large Bronchi

stenosis, glands, panting and bronchus

STENOS'S OF THE TRACHEA AND OF THE LARGE BRONCHI A narrowing of the trachea or of the bronchi occurs, in rare cases (Gregor), congenitally, otherwise almost always only as a symptom of various diseases. A short description is therefore given here for purely practical reasons only. The origin of the stenosis frequently lies in dis ease of the air-passages themselves. The most important cause is the formation of membrane in diphtheria, more rarely in fibrinous bronchitis, then also formation of granulations and softening and defects of the trachea after tracheotomy, syphilitic ulcerations and scars, foreign bodies, etc. In the second place, pressure front neighboring structures may lead to compression stenosis, as strurna (often substernal) enlarged mediastinal and bronchial glands, burrowing abscesses, pleuritic adhe sions, hygromatous cysts. Hypertrophy of the thymus has also been seen by me to be a cause of chronic stenosis of the trachea.

The symptoms come on either rapidly (foreign bodies) or slowly according to the cause. Respiration is more or less retarded and labor ious, especially inspiration which, during circumscribed stenosis, is often accompanied by a whistling and panting noise (stenosis sound). In the sternal notch, but more distinctly in the epigastrium, inspiratory re cessions appear, especially in narrowing of the trachea, to which severe cyanosis may also be added. If the cause lies in enlarged mediastinal

glands, in addition to the loud inspiratory stridor, attacks of panting and wheezing cough of a high note frequently occur. Swelling of the bronchial glands producing stenosis may often cause slight exophthal mos iFriedjung). Percussion shows a normal condition, whereas in characteristic contrast. thereto, the fremitus and vesicular breathing of the affected portion of the lung is diminished or absent.

Diagnosis of Seat.A clear voice and the moderate excursions of the larynx indicate that the stenosis is farther. below. In tracheal stenosis the stenosis sound is usually more marked, dyspncea more threatening, as if the obstruction affected only one large bronchus. In addition the cause is often directly shown (struma, scars resulting from tracheotomy). If the stenosis is in a bronchus, vesicular breathing, fremitus, and movements of the thorax, are diminished ou that side only, while the free portion of the lung is often excessively stretched and appears distended. The treatment is described in the respective chapters.