PULMONIC INTERSTITIAL EMPHYSEMA AND 



ITS SEQUELAE: AN ANATOMICAL 



INTERPRETATION * 



Iniroduction 



THE BETTER the Understanding of the functional anatomy of an organ the 

 better the comprehension of its fundamental pathology. The newer knowl- 

 edge, for instance, of the way the various parts of the lung work together to 

 subserve its function has helped materially in the interpretation of its diseases, 

 such as senile emphysema/ In a more restricted application of this principle, 

 the functional conception of the connective-tissue formations of the lung has 

 given us the means of giasping the nature and significance of pulmonic inter- 

 stitial emphysema and its sequelae. In the development of this proposition we 

 shall discuss the following among other points: how pulmonic interstitial em- 

 physema (referred to hereinafter for brevity as PIE) originates and spreads, as 

 revealed particularly by animal experimentation; some of the many clinical 

 conditions with which it is associated; and the mode of action in producing 

 its ill effects, known as "airblock," which may have serious and even fatal con- 

 sequences. Although airblock is only now beginning to be diagnosed, its phys- 

 ical basis, the aberrant air in the connective tissues of the lung, mediastinum 

 and beyond, has been revealed at autopsy, and is now being demonstrated 

 by roentgenography. From a study of pertinent clinical and pathological 

 reports in the light of our laboratory experience we believe that airblock is 

 present in serious degree more often than is realized, and hope that this em- 

 phasis on its widespread occurrence will lead to its more general discovery and 

 alleviation. Suggestions for its diagnosis and relief are given. First, let us say 

 a word on the dynamics of pulmonic connective tissue. 



Pulmonic Connective Tissue and Its Pneumatization 



The subdivisions of the pulmonic connective tissue are named from their rela- 

 tion to various lung structures; as subserous, inter- or perilobular (or septal), 

 hilar, peribronchial, and perivascular. They are confluent, and the mass ex- 

 tends directly, through the lung root, into the mediastinum and beyond. 

 Viewed in toto, this tissue is a continuum of soft succulent material, readily 

 dissectible by air which may gain entry into it. Most important of these sub- 

 divisions in its bearing on PIE is the sheath of the pulmonary arterial and 

 venous trees. This, in microsections, is seen as a layer between the vascular 



* In part as gi\cn by Charles C. Matklin on tlic in\ilati()ii pro^^^rain of the American Asso- 

 ciation of Anatomists on April ii, igji, at the l'ni\ersity ol Chicago, inicler tlie title ■"Some 

 features of the finictional anatoni) of the linig," and also befoie the Gibson Anatomical 

 Society of the University of Buffalo Medical School, on March '51, 1942, on "Pulmonic Iiuer- 

 stitial Emphysema, interpreted bv an Anatomist." Neither leduie has been published. 



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