Pulmonary diseases in the compromised host. A review of clinical and roentgenographic manifestations in patients with impaired host defense mechanisms.
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Biomedical subjects
Publications and source records attributed to R G Fraser.
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Acute pulmonary edema was induced in anesthetized vertically suspended dogs by inflating a ballon catheter in the descending thoracic aorta and infusing saline. Indices measured included pulmonary arterial pressure, left ventricle end-diastolic pressure, and cardiac output. Pulmonary blood-flow distribution was determined in frozen tissue after injecting radioactive macroaggregates labelled with 125-I, 131-I, and 99m-Tc. Randomized serial chest roentgenograms were interpreted by three radiologists not taking part in the physiologic studies. When left ventricular end-diastolic pressure was raised initially, roentgenograms usually revealed only interstitial edema. As alveolar edema increased, blood-flow to the lung bases decreased as measured physiologically. The roentgenographic and physiologic data show that in acute experiments on normal lungs, blood-flow redistribution occurs in association with alveolar edema rather than interstitial edema.
A series of experiments was carried out on 28 dogs in which the following aspects were investigated: in 9 dogs, the special configuration of acute lobar atelectasis; in 10 dogs, the pressure-volume characteristics of collapsed and non-collapsed diaphragmatic lobes; in 12 dogs, the wet-weight/dry-weight ratios of atelectatic contralateral lobes; in 6 dogs, the amount of blood sequestered in atelectatic diaphragmatic lobes was estimated. The relationships of an atelectic lobe closely resemble those described in man. Loss of apposition between visceral and parietal pleural surfaces was never observed. The W/D weight ratio of the collapsed lobe invariably was higher than that of the non-collapsed contralateral lobe indicating a slight increase in the volume of fluid in the atelectatic lobe. No pressure-volume differences were found between atelectatic and non-collapsed lobes.
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