VALSALVA lesions of tuberculosis often are confined to the upper lobes,* and Morgagni noted that they favor the upper part of the upper lobes.† Laennec repeatedly emphasized that the disease attacks the apex, and he noted that the initial cavity is found most often on the right side.‡ These facts have been confirmed by innumerable pathologists and radiologists, but in 1951, two and a half centuries after Valsalva's observations, Rich concluded that "it is certainly not possible at present to explain satisfactorily the apical localization of the disease." 3
In the last three years evidence from several sources has greatly strengthened one of the theories of apical localization. This hypothesis, restated in 1946, after a 50-year eclipse, noted that the pulmonary arterial pressure, then being measured in Cournand's laboratory,4 was too low in comparison with the force of gravity to maintain flow in the upper third of the lungs
DOCK W. EFFECT OF POSTURE ON ALVEOLAR GAS TENSION IN TUBERCULOSIS: Explanation for Favored Sites of Chronic Pulmonary Lesions. AMA Arch Intern Med. 1954;94(5):700–708. doi:10.1001/archinte.1954.00250050014003
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