Roentgenological Signs of Adhesive Pleuritis *

Prior to the general introduction of pneumothorax treatment for pulmonary tuberculosis the presence or absence of obliterative pleuritis or localized adhesions over the lung was almost entirely of academic interest. Such adhesions cause no symptoms and do not interfere appreciably with the function of the lung. It might even be maintained that the formation of adhesions is beneficial to the individual in that they protect him against extension of a pulmonary process into the pleural space and against spontaneous pneumothorax with infection of the pleura. The effectiveness of pneumothorax treatment depends upon the presence of a free pleural space over the lesions to be treated. In from 20 to 25 per cent of the cases of pulmonary tuberculosis the pleural space is found to be obliterated at the time that this treatment is first attempted. In another 35 per cent of cases adhesions over the involved lobe prevent an effective collapse unless they can be severed. Therefore, it would be desirable to be able to determine whether therapeutic pneumothorax can be successfully instituted when a case is under study as to the form of treatment best fitted to control an active pulmonary tuberculosis. Since air embolism (or pleural shock), although a rare accident, is most likely to occur on attempting this form of treatment in the presence of an adherent pleura, it is of some practical importance to make a diagnosis of obliterative pleuritis in advance. It is generally agreed by those experienced in the treatment of tuberculosis that this diagnosis is difficult and often incorrect. Patients exhibiting no evidence of pleuritis by history, physical examination, or roentgenogram are found on actual trial to have an obliterated pleural space, while others with every sign of an old pleurisy may still have sufficient pleural space to permit of a good dinical result with pneumothorax. Nevertheless, there are signs, constituting a standing challenge to the clinician and the radiologist, which aid in the pre-operative diagnosis of pleural adhesions. In tribute to Dr. Willard B. Soper I would like to review these evidences of adhesive pleuritis and to add a