Acute bronchopulmonary suppuration: therapy with endoscopic application of oleaginous penicillin.

For purpose of discussion the entity of bronchopulmonary suppuration must be better defined anatomically. With the advent of improved knowledge and standardization of the bronchopulmonary segments1 we may assume that the segment be considered the pathological unit of suppurative disease in the lung. Larger areas of pathology are made up of two or more segments up to the lobar aggregate of the component segments. The peculiar anatomical localization of bronchopulmonary suppuration, since it starts with blockage of a segmental bronchus and involves a definite segment of the lobe, makes this concept fairly acceptable and practical. The radiographic as well as the bronchoscopic manifestations of this entity both permit the possibility of using the segment as the pathological unit of suppurative disease of the lung. Again, for purpose of better definition and in consonance with the expressions in the literature,2-7 the various disease states which have been rather loosely described as “unresolved pneumonia,” “middle lobe syndrome,” “drowned lung,” “residual interstitial pneumonia,” “partial atelectasis,” “obstructive pneumonitis,” “fibrous pneumonia,” “parenchymal fibrosis,” “focal parenchymal fibrosis,” “chronic suppurative pneumonitis,” etc., may all be fitted into the segmental pattern. These are, in all probabilities, originally due to disturbances of the normal function of the segments secondary to Intrinsic or extrinsic bronchial block; and therefore different pathological manifestations of bronchial block. The pathological changes following bronchial obstruction have been fairly well studied both clinically and pathologically2.4’#{176} and the following sequellae of such block well accepted in the literature: 1) Blockage occurs from retained exudates, transudates, or aspirates (liquids or solids). Rapid absorption of the air distal to the block occurs with creation of a vacuum which retains the viscous mass. The absence of the normal air cushion distal to the block impedes the normal expulsive efforts of the lung to free the plug. Retention of the mass In time dulls the receptors which initiate the cough reflex, The cilia in turn become powerless since the mass may be too tenacious for their efforts at removal; and the spiral musculature which molds and pushes the mass cephalad