A study consisting of the morpholgical and pathological investigation for the pleural
adhesion from 100 cases of the pulmonary resection for the tuberculosis was preformed
at the Thoracic Surgery Section in 36th A. H, Masan, Korea, from 1954 through 1956in
presented, and the following conclusions were drawn.
1) Following classifications for pleural adhesion were performed by authors.(See
annexed photo)
a) Classification from the extension of pleural adhesion.
Diffuse and loose type ‥‥‥‥ 6 cases.
Localized fibrotic type ‥‥‥‥ 4 cases.
Cicatrical type on
upper portion ‥‥‥‥ 36 cases.
Cicatrical type on upper portion
plus diffuse and loose type ‥‥ 34 cases.
Entire cicatrical type ‥‥‥‥‥ 8 cases.
Caseous pleural adhesion ‥‥‥‥ 1 cases.
b) Classification from the internal construction of adhesion :
1st type ‥‥‥‥‥‥‥‥‥‥‥ 12 cases.
2nd type ‥‥‥‥‥‥‥‥‥‥‥ 11 cases.
3rd type ‥‥‥‥‥‥‥‥‥‥‥ 24 cases.
4th type ‥‥‥‥‥‥‥‥‥‥‥ 42 cases.
c) Classification from the point of external from :
Thready form ‥‥‥‥‥‥‥‥ 7 cases.
Stringy form ‥‥‥‥‥‥‥‥ 13 cases.
Band-like form ‥‥‥‥‥‥‥ 11 cases.
Mass form ‥‥‥‥‥‥‥‥‥ 21 cases.
Dense closed from
Fibrotic type ‥‥‥‥‥ 5 cases.
Cicatrical type ‥‥‥‥‥‥‥ 32 cases.
d) Classification form patho ogical view.
A type adhesion ‥‥‥‥‥‥ 11 cases.
B type " ‥‥‥‥‥‥ 78 cases
A type adhesion ogical
2) Of 100 cases of pulmonary resection of tuberculosis, 89% were combined
with pleural adhesion, and 80% of these adhesion were the cicatrical type on upper
portion and 47% were the 4th type adhesion.
3) 80% of these pleural adhesion were localized on the apico-posteriol chest wall over
the level of the 4th rib, and 60% were combined with the adhesions of interlobe,
mediastinum and diaphragma, besides adhesion above the pulmonary tuberculous lesion.
4) The pleural adhesion became more dense and more diffuse in these cases which
had passed through the pleurisy and artificial pneumothorax, in the side in which the
primary complex was seen, and in the cases of long standing patients.
5) The density and strength of Pleural adhesion above the pulmonary tuberculous
lesions are affected by such as the distance of Pulmonary tuberculous lesions, from the
surface of visceral pleura, Pathologica activity of the lesions, and the intensity of the
collagen fiber under the pleural surface and around the lesions.
6) All such cases as the cirrhotic cavities, giant cavities and multiple cavities
were always combined with cicatrical adhesions. It, however, can not be decided hat
there may be no cavities of there is no pleural adhesions.
7) The pleural adhesions were surmised from the roengenogram in 61% of resected
pulmonary tuberculous cases, and the thickend pleural adhesions usually caused the
postoperative haemorrage of the thoracic cavity and the incomplete expension of
remained lung.
8) Histologically, in pulmonary tuberculosis, the pleural adhesions are mostely (87%) B
type of adhesion, and the A type of adhesion are seen usually in cases which passed
through the pleurisy and pleurisy and artificial pneumothorax.
8) In such cases of short termed patients, exudative lesions right below the pleural
surface, and isolated cavities and tuberculomas which are distant from the pleural
surface, the pleural adhesions are free or slight.
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