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January 1927


Author Affiliations

From the Department of Surgery, University of Iowa College of Medicine.

Arch Surg. 1927;14(1):240-260. doi:10.1001/archsurg.1927.01130130244015

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The diaphragm presents a striking barrier to the spread of infection from the pleural cavity. Extension through it in cases of empyema or lung abscess is remarkably infrequent. In a series of 190 cases of acute and chronic empyemas in the surgical service of the University Hospital since Jan. 1, 1915, infection has passed through the diaphragm in only a single instance (case 10), and in this patient the diaphragm was traumatized at operation.

In infections originating below and in contact with the diaphragm, however, the likelihood of the process passing upward to involve the pleural cavity or lung parenchyma is distinct. In our series of twenty-four cases of subphrenic abscess, a transphrenic infection has taken place in eight spontaneously. In another, the pleura was opened in draining the abscess, but already there was such a marked and sudden reaction in the pleura that infection of it was imminent (case

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