Adverse effect of surgical repair of an atrial septal defect in a patient with associated left ventricular disease.
نویسندگان
چکیده
This case, together with a few case reports by others,*-? forms a distinct group of endobronchial polyps characterized by rapidly progressing signs and symptoms of bronchial obstruction in the absence of preceding manifestations of tracheobronchial or pulmonary disease. The tenn polyp, per se, has no histopathologic connotation; it just means a protruding growth arising from a mucous membrane. As such, the term well applies to the endobronchial mass of our case. All attempts to classify the bronchial polyps according to their presumed dominant etiology or their histologic appearance have failed to clarify their mechanism of formation. Probably the safest categorization is that suggested by the JacksonsZ acknowledging two major types of polyps: the inflammatory, displaying a frank granulomatous or inflammatory component, and the noninffarnmatory, exactly duplicating the enigmatic structure of the nasal polyps in their variable fibrous, myxomatous and vascular components. The microscopic structure of the polyp in our case well fits in the latter category. Samteld has considered the nasal polyp a disease of the vascular bed, in the sense that increased capillary permeability and immigration of inflammatory cells can be produced by a variety of injuries, including sensitization to bacteria or to other allergens. One is tempted to apply the same concept to the interpretation of our bronchial polyp. Vascular congestion and tissue edema were prominent histologic features. It may well be that the pressure resulting from the accumulation of intracellular and extracellular-bound edema fluid pushed forward the mucous membrane, giving rise first to folds and projections and then to massive mucosal herniation, which ultimately was responsible for the occlusion of the bronchial lumen and the ensuing pulmonary atelectasis. The extremely moderate polymorphonuclear infiltration can find a likely explanation in the increased capillary permeability, from trauma or secondary infection, or a combination of both.
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ورودعنوان ژورنال:
- Chest
دوره 63 1 شماره
صفحات -
تاریخ انتشار 1973