Gangrenous Metastasis from the Lungs to the Brain. By Rud.
Virchow —I have already, in my work upon inflammation of arteries,
(Virchow’s Archiv., Bd. I., S. 332,) communicated a case where, in a
patient who died of gangrene of the lungs, there were found in the
mesentery gangrenous deposits, which more minute investigation proved
to be lodged within the branches of the mesenteric artery, such deposits
having come from the gangrenous lung by the pulmonary veins, and
been propelled from the left side of the heart into the systemic circula-
tion. As this form of metastasis has not yet been much investigated,
the relation of afresh case may serve to arouse the attention of pathologists.
Anna Maria Schwing, of Buchold, aged21, came to the Julius Hospital,
May 18th, 1852, suffering from melancholia religiosa, accompanied by
occasional maniacal fits. From June 10th to two days before her death,
she exhibited the most determined abhorrence of food. From July 8th,
there were symptoms of severe affection of the lungs, characterised by
fetid and blood-stained sputa, paroxysms of asthma, and uncontrollable
fits of cough. Her excited state prevented a more accurate examina-
tion. Death ensued August 8th, at a quarter past seven A. M., with-
out any further cerebral symptoms.
Examination of the Body, August 9.—Skull-cap thin, but normal;
sinuses empty, but superficial; cerebral veins full; numerous granula-
tions (gland. Pacchioni ?) along the sinus long.; considerable serous
effusion at the base of the skull and in the ventricles; cerebral sub-
stance firm. In the left ventricle, and extending over both the optic
thalamus and corpus striatum, there was a discoloured, dirty grey sur-
face, under which was a whitish semifluid, or crumbling mass of limited
extent. Upon further examination, four similar spots were seen upon
the posterior surface of the hemispheres, under the pia mater, and in
the sulci; they consisted of a white, semifluid, stinking substance, sur-
rounded, as in the ventricle, by a dirty grey circumference. The micros-
copical appearances of this substance showed that it consisted of an
amorphous granular detritus, with long, spear-shaped, fat crystals, (such
as I have shown to occur often in gangrene of the lung,) pigment masses,
and altered blood-discs. Parts of the mass were traced, under the micros-
cope, into the arteries of the pia mater.
Old adhesions on both sides of the chest; recent effusions of lymph
over gangrenous portions of the visceral pleura. The right lung was
torn in separating its adhesions; and, from the fissure, there issued a
thick, dirty, grey, and partially brownish, stinking substance, which
had been enclosed in a cavity with defined wal’s. There were many
other similar accumulations scattered throughout the pulmonary sub-
stance, one as large as a hen’s egg. The microscopic characters corres-
ponded with those mentioned in the cerebral deposit.
It may be inferred, that, in consequence of imperfect nutrition, gan-
grene of the lung first ensued; then small granular particles became
detached, entered the left side of the heart by the pulmonary veins, and
thence were driven through the carotids to the pia mater, where they
spread the decomposing process to the structure of the brain. The
spots were of limited extent, the surrounding vessels and tissues being
normal.— Virchow’s Archiv., 1853.
Dr. Kirkes observes, in speaking of the detachment of fibrinous deposits
from the interior of the heart: “ The finely granular material resulting
from their disintegration, mingling and circulating with the blood, may
give rise to various disturbances indicative of a contaminated state of this
fluid, producing symptoms very similar to those observed in phlebitis,
typhus, and other analogous diseases.’’ This remark may be extended
to disorganization going on in the lungs, and perhaps in other organs;
and the cases related by the different authors who have written upon
this subject should stimulate those upon whom the responsibility of
making post-mortem examinations falls, to investigate, more thoroughly
than has heretofore been done, the condition of the interior of arteries
and veins, both in their main trunks and in the immediate proximity of
diseased tissues.—Lon. Med. Times & Gaz.