Excerpt from The American Practitioner and News, 1904, Vol. 37: A Semi-Monthly Journal of Medicine and Surgery
Chronic pneumonia is liable to be confounded with pleurisy with effusion, pleurisy with retraction, collapse of the lung, cancer of the lung, pulmonary tuberculosis. From pleurisy with effusion it will only be necessary to differentiate that form following acute lobar pneumonia. The well defined physical signs present in these cases leave but little room for doubt; the bronchial breathing, increased vocal fremitus, and the absence of bulging of intercostal spaces and absence of enlargement of the affected side, compared with the bulging of the intercostal spaces with displacement of the heart that occurs in very large effusions is usually sufficient for a clear diagnosis.
From pleurisy with retraction the diagnosis is not so easy, as there is retraction in both, but in pleurisy the retraction is accompanied by more twisting of the ribs upon their axis, with more falling of shoulder and tilting outward of the angle of the scapula, the retraction in chronic pneumonia being more uniform and a more general diminution of the affected side. Again, fetid expectoration, hemoptysis and fever may be present in chronic pneumonia, but never in pleurisy with retraction.
In cancer of lung, the history aids us very much. The line of percussion dullness extends across the median line, while in chronic pneumonia the sound lung is emphysematous, and encroaches upon the affected side. In cancer the hemoptysis is much more profuse, and the peculiar current jelly expectoration of cancer has not been known to occur in chronic pneumonia, pain is more frequent and severe, and the disease runs a much more rapid course, accompanied by involvement of the lymphatic glands, associated with the cachexia of malignant disease.
Collapse of the lung is rare. It is rare to have collapse of the entire lung except from the presence of a foreign body in the bronchus or from pressure of a thoracic tumor. Along with this we would likely have other pressure symptoms; this, in connection with absence of fever and other physical signs, would lead to the correct diagnosis. In pulmonary tuberculosis the disease is more progressive and rarely remains unilateral. Fetid sputum is rare in tuberculosis, but com mon in chronic pneumonia. If laryngeal and intestinal symptoms are present, it is largely in favor of tuberculosis.
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