Regressive Giant Bullous Emphysema in Tuberculosis of Adults

In the last two years several reports have been published on large multiple bullae developing within the parenchyma of the lung with tendency to grow or to decrease and eventually to disappear.

This type of lesions is seen in tuberculous patients treated with antibiotics and particularly in those treated with isoniazid.

The number of cases reported is not large, the author has been able to find only 25 cases in the European and South American literature and only one in the United States.

The main features of this peculiar type of tuberculous disease are described and a new case is presented with tomograms, angiograms, roentgenograms, etc. illustrating an extreme example of multiple cyst like cavities which during the course of the disease increased to 14 bullae in the right and 15 in the left lung which later regressed to four in the right and two in the left.

The mechanism of this condition is discussed at length and an hypothesis of its development is presented.

According to the author these cavities could develop under conditions which rarely assemble: Destruction of lung tissue large or small but multiple. Changes in the innervation and vasculo-nutrient factors in the lung, and particularly adhesion of both pleurae bringing about a mechanism of suction toward the defect favored by the patency of the bronchi already cleansed and patent, under the action of the antibiotics and especially under the influence of isoniazid.

The regressive trend is explained by the restoration of the blood supply through newly formed vessels or shunts between the lesser and the systemic circulation favored by the phenomenon of fatigue of the constrictive action of the drugs on the bronchial vessels.

In the case presented another rare factor is considered: the use of a vaccine of living bacilli (Friedmann's) could produce a multiple Koch phenomenon which caused numerous defects later filled by the described mechanism of suction.