Surgery of the Definable X-ray Lesion in Apparently Healthy Military Personnel

¹ U. S. Naval Hospital.
² U. S. Naval Hospital., Chief, Department of Surgery, The Mount Sinai Hospital, New York, N. Y.

During the two year period from January 1955 through December 1956, 102 healthy asymptomatic patients with abnormal chest x-ray findings were subjected to exploratory diagnostic thoracotomy at the United States Naval Hospital, San Diego, California. In 89, instances a granuloma was found and excised; of these, 48 were nonspecific, 23 were tuberculosis, 15 were coccidioides, two were histoplasmosis and one was lipoid granuloma. Only two cases of carcinoma were encountered in the study, and it was presumed that the lower average age of 32 years accounted for the disparity between our experience in this regard and the reported experience of others. The remainder of the diagnoses included congenital absence of the pulmonary artery, bronchopulmonary sequestration, congenital cystic disease, hamartoma, adenoma, pericardial cyst, exostosis, and no disease. Whereas other studies yielding a high incidence of malignant neoplasms have stressed the importance of silent pulmonary nodules for the purpose of obtaining early diagnosis and significantly higher cure rates for carcinoma of the lung, the military population, being rather younger, appears not to harbor the large numbers of occult malignancies found elsewhere. In this younger segment, the potentially dangerous nature of the granuloma partially takes the place occupied by carcinoma at a later age, for although the 25 per cent reactivation predicted for such lesions rarely has a fatal or even serious outcome, the loss from active service of these individuals through disability retirement or prolonged hospitalization can be prevented by excision of the lesions at an early, asymptomatic, inactive time with minimal morbidity and mortality. Significant complications occurred in five cases, only one of which resulted in failure to return to full active service. There was one death due to postoperative shock of undetermined cause. Seventy-nine per cent returned to full service and as recent changes in Medical Department policy are implemented to take into account the favorable long-term results of combined medical and surgical management of pulmonary tuberculosis, it is believed that more than 90 per cent will be rehabilitated for continued active Naval service.