A 33-year-old veteran was admitted to the hospital on March 3, 1955, because of pulmonary symptoms, which first had developed eight years previously. Fever had been the chief symptom, but other symptoms also included a hacking cough, expectoration of sputum, which occasionally had been blood-streaked, and a minimal systemic reaction. In 1947, when the symptoms had first occurred, roentgenographic examination had disclosed an apical lesion in the left lung. At that time, a pneumothorax had been induced, and it had been maintained until 1950.
The Roentgenographic examination then had disclosed recent infiltration in the upper part of the right lung. In 1952, air had been injected into the peritoneal cavity, and the pneumoperitoneum had been maintained until the patient was admitted to the hospital on March 3, 1955. To the best of the patient's knowledge, examination of his sputum never had disclosed the presence of acid-fast bacilli. When the patient was admitted to the hospital, he weighed 129.5 pounds, and the left side of his chest was flat.
Physical examination revealed a reduction in the intensity of the breath sounds in the posterior part of the apex of the left lung, dullness at the base of the left lung, and reduced excursion of the left side of the chest. A roentgenogram of the chest was similar to the one which had been made three years previously and which had disclosed calcified stippling in the upper part of each lung, deviation of the trachea to the left, and two thin-walled cavities in the upper part of the left lung (figure 1). The pleura surrounding the left lung was thickened to a width of 2 em. Microscopic examination and cultures of two specimens of the sputum disclosed H. cap done in August 1956. Roentgenogram made five years after the onset of symptoms showed the maximal extent of the lesion in the apex and pleura of the left lung. It also showed a therapeutic pneumoperitoneum. sulatum. The histoplasmin and Mantoux skin tests were positive.
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