INTERSTITIAL EMPHYSEMA OF THE LUNG WITH SPONTANEOUS PNEUMOTHORAX AND SUBCUTANEOUS EMPHYSEMA: DEMONSTRATION OF AIR IN THE SEPTUMS OF A HUMAN LUNG

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Abstract
Pneumothorax with subcutaneous and mediastinal emphysema has long been known to occur in association with increased intrapulmonary pressure. Obstructive lesions of the larynx, trachea and bronchi are not infrequently accompanied by these conditions, which may become evident after tracheotomy. Mediastinal and subcutaneous emphysema, with or without pneumothorax, may occur also in otherwise healthy persons who do not present any evidence of increased intrapulmonary pressure. These conditions, occurring singly or simultaneously, have been recently brought to the attention of the members of the medical profession by Hamman,1 McGuire and Bean2 and Graebner.3 The pathogenesis of pneumothorax with mediastinal and subcutaneous emphysema was never explained satisfactorily with the aid of post-mortem examinations, as no definite rupture of the lung and parietal pleura was demonstrated in the majority of necropsies. The pathogenesis of these conditions was, therefore, until recently a matter of conjecture. Bullowa4 described subcutaneous emphysema without pneumothorax occurring in association with

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