%0 THE CORRELATION OF X-RAY FINDINGS AND PHYSICAL SIGNS IN THE CHEST IN UNCOM- PLICATED EPIDEMIC INFLUENZA By Arthur L. Bloom field and Charles A. Waters (From the Meaical Clinic and the X-Ray Department of The Johns Hopkins Hospital) [From The Johns Hopkins Hospital Bulletin, Vol. XXX, No. 342, August, 1910] THE CORRELATION OF X-RAY FINDINGS AND PHYSICAL SIGNS IN THE CHEST IN UNCOM- PLICATED EPIDEMIC INFLUENZA By Arthur L. Bloomfield and Charles A. Waters (From the Medical Clinic and the X-Ray Department of The Johns Hopkins Hospital) The exact significance of the pulmonary lesions associated [252] with epidemic influenza is still a disputed question. In a recent report1 the view was expressed that bronchopneumonia, although occurring frequently along with or following influ- enza, was not an essential feature of the disease, but a com- plication. This opinion was based on the study of an epidemic of severe cases most of which ran their course without demon- strable pulmonary involvement. It seemed possible, however, that small areas of pneumonia might exist even without cough, sputum, or physical signs, especially in the cases in which fever persisted for more than three or four days. The present study was undertaken to see what light roentgenographic examina- tions would throw on this question. The material consisted of 16 consecutive cases of uncom- plicated epidemic influenza treated in the wards of The Johns Hopkins Hospital during January and February, 1919. The diagnosis was based on the symptoms, the hyperaemic phe- nomena of skin and mucous membranes, the course of the disease, the duration of the fever, and the presence of leuco- penia. In no case was there any evidence of pulmonary com- plications—the lungs remained clear throughout on physical examination, and cough, if present, was dry and productive only of the usual slight mucoid expectoration associated with the hyperemia of the mucosa of the upper respiratory tract. 1 Bloomfield A. L. and Harrop, G. A., Jr.: Bull. J. H. H., 1919, XXX, 1. (1) TABLE I COMPARISON OF CLINICAL AND ROENTGENOGRAPHIC EXAMINATION OF THE CHEST IN UNCOMPLICATED CASES OF EPIDEMIC INFLUENZA ____ 30 January 22 " 29 January 21 " 23 25 27 29 f+'ebruarv 1 \V. .. . February 11 12 17 20 February 10 3. C... February 11 D----iFebrua 104° Normal 101° Normal 103° 102° Normal 100° Normal 100° 100° Normal Normal 102° Slight, dry 0 0 Slight, drv 0 Slight, dry 0 Slight Normal I Slight, dry Normal Slight, dry Day on which temperature became norma] 0 0 0 0 Slight, mucoid Slight, mucoid 0 0 Slight, mucoid No signs of consolidation. Well marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Well marked root shadows on both sides. Apices clear. Bases clear. Calcified glands (?) at root of right lung. Pulmonary field shadows remain unchanged. No signs of consolidation. Marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Very marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Marked root shadows on both sides. Slight clouding of right apex. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Very marked root shadows on both sides. Calcified glands (?) in left root. Apices clear. Bases clear. 12 February 4 February 11 13 15 17 February 15 18 24 February 12 14 17 February 10 January 25 27 " 29 February 1 February 1 103° Normal 101° Norma] 102° Normal 100° Normal 100° Normal 101° Normal 102° Normal 100° Norma] 102° Normal 0 Slight 0 Slight, dry 0 0 = 0 Moderate muco- purulent Pulmonary field shadows remain unchanged. No signs of consolidation. Marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Very marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Very marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Moderately marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Moderately marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. No signs of consolidation. Well marked root shadows on both sides. Apices clear. Bases clear. Pulmonary Meld shadows remain unchanged. No signs of consolidation. Well marked root shadows on both sides. Apices clear. Bases clear. Pulmonary field shadows remain unchanged. [254] Poentgenographic examination of the chest was made as soon as possible after admission and thereafter at two- or three-day intervals until the patient was discharged. Each series of plates was studied with two points in mind—first to discover and interpret any abnormal markings, and secondly, to deter- mine any variations in the pulmonary shadows during the course of the disease. RESULTS The results of the examinations are summarized in Table I. In no case was there any detectable change in the appearance of the lung markings in a series of from three to six plates made at various times during the febrile and post-febrile con- valescent stages of the disease. It would seem, therefore, that the markings were permanent or at least unassociated with the immediate acute disease. In no case was any shadow seen which could be interpreted as indicating a solidification of the lung. The usual grades of root shadows, in some cases small areas of probable calcification (glands ?) resulting from infec- tions prior to the influenza, and in others slight degrees of apical clouding were seen. It is not the present purpose to discuss the exact significance of pulmonary shadows in general. CONCLUSIONS 1. Kepeated roentgenographic examinations of the lungs during the course of clinically uncomplicated cases of epidemic influenza showed only permanent lung markings. 2. These findings support the clinical impression that bronchopneumonia is a complication and not an essential feature of the disease. (4) THE JOHNS HOPKINS HOSPITAL BULLETIN, AUGUST, 1919 PLATE XXIX A l|aip1 SERIES OF PLATES FROM CASE A THE JOHNS HOPKINS HOSPITAL BULLETIN, AUGUST, 1919 PLATE XXX 'Tn^ Y>\n\»- B A|n|'ii. SERIES OF PLATES FROM CASE B. THE JOHNS HOPKINS HOSPITAL BULLETIN, AUGUST, 1919 *^r- J. Ajffl-I PLATE XXXI «t- 1 >-« 1 \4-V, 1^ S ft1 J l.'jj'l !• J. UMn. mh J <|u''n I '•<-. SERIES OF PLATES FROM CASE J.