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A 64-year-old man with far-advanced IgA multiple myeloma presented with fulminant and rapidly fatal bronchopneumonia. Gram stains of expectorated sputum and of transtracheal aspirate revealed gram-negative intracellular and extracellular diplococci. Cultures of these specimens yielded Neisseria catarrhalis. Subsequent histologic examination of the lung confirmed the presence of numerous gram-negative diplococci in the alveolar spaces. The pathogenic potential of this nasopharyngeal commensal is discussed in both the normal and the immunosuppressed host.

The radiologic findings in 123 hospitalized children with viral disease of the respiratory tract due to adenovirus, respiratory syncytial virus, parainfluenza, influenza, measles, or herpes virus were retrospectively reviewed. Bronchial wall thickening, peribronchial shadowing and/or associated perihilar streaking were present in 107 cases. Patchy pulmonary shadowing thought to reflect disease at a sublobular or lobular level was present in 72 cases, while areas of coalescent more homogeneous pulmonary shadowing were present in only 20 cases. In general the pulmonary abnormalities were widespread; on the average, two to three lobes demonstrated abnormal pulmonary findings. Poorly defined small pulmonary nodules, while radiologically unimpressive, were noted in 49 cases. Air trapping was observed in 61 cases. Hilar adenopathy was seen in only four cases and was unimpressive. There was a striking absence of pleural effusion, pneumothorax, pneumatocele, and lung abscess in the patients examined.

A very brief review is given of the pathology of primary pulmonary tuberculosis. Numerous characteristic, but not pathognomonic, radiological appearances of primary pulmonary tuberculosis are briefly described and some of them are illustrated. The final diagnosis, however, depends on correlating the radiological picture with the clinical picture and special investigations.

The clinical, roentgenological and pathologicanatomical findings in 101 deceased premature and newborn infants, delivered in the years 1968-1971, have been studied by transferring the data on to punch cards for the purposes of comparison and analysis. A full or partial conformity of the X-Ray findings with the pathologic-anatomic diagnosis was found in 72 cases. It has been concluded that a distinct radiomorphologic substrate is often caused by a combination of various pathologic-anatomical changes.

Salmonella typhi bacilli were isolated from the pleural aspirate and the blood culture of an 8-year-old girl who presented with clinical and roentgenographic alveolar pneumonia. There was no accompanying gastrointestinal manifestation. The literature on pneumonia in typhoid fever is briefly reviewed.

In 20 children with bronchopulmonary symptoms and striking x-ray-thorax-findings computer-tomography examinations were carried out in addition to the usual diagnosis. Mediastinal demand for room and screening for tumor are recognized as essential indications in infancy for the application of CT-diagnosis in the chest. Computerized tomography is also indicated if an anomaly of blood vessels is suspected. In all other pulmonal diseases CT gives valuable information but in no case it replaces a bronchologic examination.

Papers on deposition pattern analyses of radio-aerosol lung scans are few and not easy to interpret as there is a general lack of technical standardization and the number of patients studied is not large. Moreover these reports have been generally obtained with non-hydrosoluble radioaerosols. In the present study 43 patients underwent conventional pulmonary function testing and lung scanning using small droplet (equal or less than 2 microns) polydisperse 99mTc-DTPA radioaerosol produced with the "Settling Bag System"--Medi 400 (Sorin). The scans were analysed by two methods: a semiquantitative method proposed by Taplin (SQT); an original simpler semiquantitative method (SQM). Correlations of SQT and SQM with FEV1 and MEF75 resulted highly significant (p less than 0,001). SQM proved to be superior to SQT as far as reproducibility is concerned. The following conclusions can be drawn: small particle 99mTc-DTPA aerosol can be easily and cheaply produced by a commercial device; such a radioaerosol is well suited for the evaluation of small and large airways patency, as reflected by MEF75 and FEV1 respectively, with a diagnostic yield comparable to non-hydrosoluble radioaerosols; the original semiquantitative description of the deposition patterns proposed and validated in this study is quite easy to implement and it yields a high correlation with pulmonary function tests; moreover such an approach does not require digital data processing; the sensitivity of 99mTc-DTPA for the diagnosis of bronchial obstruction is very high and superior to routine pulmonary function tests; in addition the ventilation scan allows the topographical localization of the obstructions themselves.

We describe an infrequent case of combined infection of bone, articulation and lung by Staphylococcus aureus, with affectation of all pelvic bones. Studies with 99m Tc pyrophosphate were repeatedly negative, becoming positive following the appearance of radiological signs.

Two cases of "phantom tumors" of the right lung on elderly subjects with congestive heart failure are described. One presented a picture of patchy bronchopneumonia, whereas the second had been diagnosed as a lung carcinoma 1 month before hospitalization because of a round lesion. In both cases the radiological picture cleared up within a few days following rest, diuresis and digitalization. The possibility of congestive heart failure as a cause for development of circumscribed pulmonary opacities should always be kept in mind.

Aspiration and its potential complications, bronchopneumonia and other pulmonary diseases, were studied in 67 fully conscious and mobile patients with cineradiographically verified dysfunction of swallowing. They were compared to a group of 67 patients of similar age with normal swallowing. Bronchopneumonia was found in nine (13%) of the patients with aspiration compared to two (3%) of the patients without (p = 0.05). Chronic pulmonary disease was more frequently observed in patients with aspiration than in those without, seven (10%) and one (1.5%), respectively (p = 0.03). Even though pulmonary complications of defective closure of the laryngeal vestibule are not frequent, swallowing training for fully conscious and relatively mobile patients would seem desirable.

A premature girl (birth weight 1 405 g, gestational age 32 weeks) was mechanically ventilated for 36 days because of respiratory distress, pulmonary hemorrhage and ductus arteriosus. The hemodynamically active ductus was ligated on the 22nd day of life. At the age of three years a mycoplasma pneumonia and a pulmonary hemosiderosis developed. The possible etiologic role of the neonatal lung problems and the mycoplasma infection for the pulmonary hemosiderosis is discussed. Because a similar case has thus for not been reported the coincidence may be by chance.

In four children, aged respectively 2, 6, 8 and 11 years, an abnormality of the aortic arches was discovered fortuitously during bronchoscopy. The latter was carried out in an attempt to assess bronchial lesions in children suffering from chronic or recurrent bronchopneumonia. The authors stress the importance of careful examination of the mediastinum in such cases, the diagnosis of the causal vascular abnormality (double aortic arch in all four cases) being possible by simple radiological examinations with no element of aggression.