Other me~:hanisms for the development of lamellae 
from radiating structures are also possible. For in­
stance, altered water content or tissue atrophy may 
cause local changes in lung tissue. Local electroosmo ­
tic effects on the distribution of pulmonary water 
around a mass will later be presented as one of the 
integrated factors in the development of the radiolu­
cent "A" zone (Chapter IX). Vascular effects, con­
nected with the developmenl of local tissue atrophy 
within the "A" zone, will be treated in Section G and 
in Chapter XIV. These effects, in brief, comprise 
field-induced changes on local blood supply around a 
locally polarized tissue within a closed clt-ctric ci.rcuit. Partial displacement of Structures in the lung is also 
known to take place in local emphysema. Such dis­
placement is probably the case around the necroti7ing, 
poorly differentiated, cavitary, squamous cell carcino­
ma seen in Fig. III: 29. In the selected left posterior 
oblique projection, fiv·e coarse and broad based radiat­
ing structures can be seen perpendicular to the tumour 
surface. In this case the mass is clearly not collapsed, 
suggesting that the coarse radiating structures derive 
their shape and di.rection from emphysema tous 
changes in the pulmonary parenchyma. Coarse radiating structures can therefore develop 
around a tumour without any appreciable partial col­
lapse of a necrotic centre. When emphysema is present 
in lung around a tumour, the structures may be called 
infiltrated strands. In this way a distinction may be 
suggested regarding the development of coarse: radiat­
ing structures. The idea has been forwarded in the literature (8-H)) 
that ulinear shadows" crossing a tumour is a diagnos .. 
tic sign of malignancy . In the author's opinion, most 
linear structures wbich seem to cross a tumour are 
merely lamellae super-impose .d over it. Obliquities of 
radiographic projection are usually essential for proper Fig. III: 29. Poorly differentiated squamous cell carcinoma 
in the left upper lobe of a 78-ycar-old man (left posterior 
oblique projection ). A large cavity in the tumour contains air 
and fluid. Lung surrounding the tumour is irregularly em· 
physemarous. Along the anterolateral aspect of the tumour, 
broad-based triangular structures radiate among emphyse­
matous bullae. Although necrotic, the tumour has no1 col· 
lapsed. In such case the radiating structures may be called 
it~filtrated strands. apprectauon of the linear changes. When a linear 
structure appears to cross through a tumour, it is 
likely that this structure is outside the tumour. There 
are virtually no reasons why a malignant tumour 
should dcvc1op a dense "linear structure " crossing 
through it. G. Narrowing and circular 
displacement of vessels 
around lung tumours 
The reader may already have noticed that vessels 
around some of the presented tumours are narrow, 
tapered and of irregular calibre. In addition the vessels 
seem to deviate in a circular fashion as if they were 
avoiding the tumour (Fig. HI: 8). These radiographi ­
cally observable structural changes will now be de­
scribed in connection with the illustrated cases in Figs. III: 30-34. A metastasis from a breast carcinoma (Fig. III: 30) 
shows circularly arranged, rather thick vessels which, 
on first glance, simulate an "A" zone. No clear radio­
graphic evidence, however, of increase.d radiolucency 
Malignant and benign neoplasms 3 I Fig. Ill :30. Circular displacement or vessels around a 
wmour. Metastatic bre:.lSt carcinoma, anterior St.'gmtJU. left 
upper lobe, in a 53-year-{)ld woman. (a) Posteroanterior pro-
is evident in the area between lhe tumour surface and 
the circularly arranged vessels. A poorly differentiated squamous cell carcinoma 
(Fig. III: 31) is seen in the anterior segment of the left 
lower lobe. Some vessels appear narrow, as seen supe-
Ftg. Ill: 31. 47-year-old man. POQrly differenti:ued squa­
l'rlOus cell carcinoma. antcromedi;ll basnl segment 1 left lower 
lobe. (a) Posteroanterior projeccion. Lung tissue close to the 
surface of the rumour shmvs absence of large \•essels. (b) In 
32 Malignant and benign neoplasm s jection. (bl Latci"Jl projection. Circularly running vessels 
(arrows) are seen l-2 c;m (rom the surface of the tumour. rior 10 the tumour in the frontal view (a). In the lateral 
view (b), large vessels superior to the tumour appear 
displaced away from its surface. Anterior tO the mass 
is a striking lack of small vascular branches. At least 
two fairly large vessels are considerably narrowed and 
1he lateral view large \'essels SUJXrior to the tumour arc ~en 
displaced away rrom i1s surface. Around the tumournre also 
seen locail)' narrowtd, irregular ,•essels (t'HYO\\'S). Fig. Ill: 32. Three metast.as<!S from earcinoma of the breast 
in aSS-year-old woman. (a) The largest tumour is surround· 
cd by vessels (arrow). A translucent ring, 2-4 mm broad, 
surrounds the tumour. {b) Nine months later the rumours 
have grown. The large me<astasis still shows a 2-4 mm a vas-
peripherally irregular. By their slightly anterior devi· 
ation from the tumour they also give a visual impres­
sion of a radiolucent zone anterior to the mass. The 
average visual radiographic density, however, in this 
area is not clearly decreased. The development of narrow, tapered, irregular and 
circularly displaced vessels is preferably studied by 
systematic inspection of radiographs from different 
times in the natural history of the tumours. For in· 
stance, in Fig. III: 32 three metastases from a breast 
carcinoma are seen in the left lung. The large central 
metastasis is surrounded by (a) circularly positioned 
vessels (arrow) and a zone, 2-3 mm broad, free of 
vessels. Nine months later (b) all three metastases have 
increased in size. The largest tumour has increased in 
length from 18 to 23 mm. The vessel above it (arrow) 
appears increased in length, as if this vessel had been 
stretched. Note that the distance to the tumour is 
unchanged. Another vessel, branching medial to the 
tumour, also undergoes progressive displacement of its 
branches away from the tumour during the observa­
tion period. A comparison of small vessels within 5~ 
em of the tumour also shows that a regional general 
narrowing of vessels has developed during the nine 
months interval. Another example is illustrated in Fig. Ill: 33. Fig. a 
shows the left lung of a 46-year-old man in 1962. The 
vessels have smooth walls and ordinary course and 
calibre. Eleven years later (b), a small tumour is seen cular zone. The \'essels superior lO this zone are now 
stretched (arrow). Two vascular branches medial to the tu­
mour have moved apart. The calibres of vessels appear de­
creased within a region of 5-6 em diarnerer around the 
tumour. in the left lung. The vessels in tbe superomedial part 
of the lung seem to have the same calibre as in 1962. Some vessels already are tending to deviate away from 
the region of the tumour. Nin.e months later (c), the 
tumour has grown considerably. Radiating structures 
are now seen perpendi cular 10 its surface. The vessels 
arc particuJarly narrow in the lower lobe inferior to the 
tumour. The vessels also have irregular walls and are 
displaced away from the tumour, as compared with 
Figs. a and b. Only the large, central pulmonary ancry 
and the vessels in the superomedial part of the lung 
have about the same calibre in the three different 
examinations. A semiaxial projection (d), from the 
same time as fig. c, shows clearly a circu.lar deviation 
of a na_rrow vessel superior to the tumour. The displacement of vessels i• often diflicult to 
observe in ordinary plain films. Fig. III: 34 a, for ex­
ample, shows a squamous cell carcinoma in the poste­
rior basal segment of the right lower lobe. Arrows here 
point tO a radiolucent zone medial to the tumour. In a 
computerized tomogram , however (Fig. III: 34 b), a 
zone one centimetre broad is easily recognized be· 
tween the tumour and circularly displaced vessels. Later experimental demonstration (Chapter XIV) will 
show that the circular deviation and narrowing of 
vessels arc likely to be caused by extensive thromboses 
and atrophy of the lung tissue around the tumour. This locally degenerated tissue is then passively dis· 
tended by surrounding nonatrophied tissue. Malignant and benign neoplasms 33 Fig./11:33. GraduaJ carcular displacement and dt:erease in 
calibre of vessels surrounding a primary adenocar cinoma in 
the lcrt upper lobe of a 57-year-old man. (a) Age 45. Vessels 
appear normal. (b) Age 56. r\ tumour, about 10 mm io dianr 
etcr. is seen in the left lung. The ves::tcls in lhc hilum and Lhc: 
medial part of the upper lohe h:wc about the ~:lme coljbrc as 
seen in u. Around the tumour the Vl. "SScls appear narrow. \X1ithjn a 6 em diameter they take a circul:u course. (c) Age 
57. A rad1olucenr "A" zone appears nround the ttl!mour. Ra· 
dialing sttuccures are also seen. The vessels arc now more 
narrow than in band deviate in a circular fashion, particu­
larly interior to lhe lUmour. (d) Ag-e 57. Semiaxial proiectjon 
sh<.1ws narrowing and circular deviation of vessels superior to 
the rumour. H. Differential diagnosis: 
"B" zone, pleural thickening 
and "retraction pocket". Pathogenesis of local 
retraction of lung and pleura 
That a "B" zone can easily be distinguished from 
atelectasis by the injection of a sm•ll amount of air iiuo 
the pleura has previously been shown (Figs. Fig. Ill: 34. Circular displacement of vessels around a squa­
mous cell carcinoma of lhc nght lower lobe in a 6H~year·o.ld 
man. (a) Posteroanterior projection. A barely visible radiolu· 
cent zone is seen medial to the carcin(lma (arrows). (b) Transverse compulerized tomogram at the level of the 
cemre of the nunour. Large pulmonary vessels mcdjaJ to the 
tumour seem to avoid its surface. The radiolucent zone ap­
pears here clearly interposed between the vessels and the 
mass. rtl: 11-13). A "B" zone and a density of pleural origin 
can usually be distinguished on the basis of radiologic 
findings on plain films, even though conclusive proof 
may require injection of air into the pleura. The different findings are schtmatica lly illustrated 
in Fig. Ill: 35. The "B" zone (a) has broad, diffuse, 
hazy, ill-defined , intrapulmonary borders except 
where it reaches an anatomic borderline , such as a 
segmental or interlobar septum, where the margin is 
sharp. An arcade of small arches can often be demon­
strated. The "B" zone disappears after injection of air 
into the pleura (b). Locally thickened pleura (c) is 
usually irregular. Its distal ends usually taper. The 
pleural space is often obliterated w that local pneumo­
thorax is impossible (d). A "retraction pocket" (e) is 
character ized by linear st.rands which connect with a 
funnel-shaped density continuo us with the convex 
margin of tbe lung. After air is injected into the pleural 
space (j), the density may completely disappear. The 
lung tissue is then seen to be limited by persisting local 
retraction of the visceral pleura. Malignant and ben.ign neoplasms 35 "B" zone Thickened pleura 
a c 
• 
b d 
• 
36 Malignant and benign neoplasms Retraction pocket 
f Fig./I/:35. Differemialdiag· 
nosis of local "pleural thick· 
ening". A "B" zone (a) disap· 
pears when (b) air has ente.red 
the pleural space. (c) True lo· 
cal pleural thickening. The 
pleural space is obtitetllted, 
corresponding to the thicken· 
ing. It does not open when 
(d) air enters the pleural 
space. (e) Visceral pleutll re· 
trdcted toward a tumour by 
shrinking fibrous strands (ra· 
diating structures ). A retrac­
tion pocket of the pleur• allows 
local accumulation of pleural 
Ouid. This Ouid disappears 
after(/) the injection of air 
into the pleura, but the retrac· 
tion of the lung tissue persists. Fig. III: 36. Pleural retraction pocktts latetlll to a squamous 
cell carcinoma, left lung, 77-yea.r-old man. (a) Postcroanter .. 
ior projection. A radiolucent "A .. zone surrounds the tu­
mour. A "B" zone (arrows) was first suggested in lung adja­
cent to the lateral chest wall. (b) Lateral projection. (c) 
Transverse computerized tomogram reveals two funnel· 
shaped pleural densities typieal of retraction pockets (RP), 
opposite two lateral protrusions of the tumour. Fig. II/: 37. Pleural retraction pocket (arrows) adjacent to an 
adenocarcinoma in the left upper lobe of a 69-year-old man. (a) Posteroanterior and (b}oblique radiograph s. (c} Postmor­
tem radiograph of the left upper lobe, distended by negative 
external pressure. Numerous small radiaring suuctures sur .. 
round the tumour bur arc: nor \'isible in the in vivo radio­
graphs a and b. One of these radiating structures extends to the retracted funnel-shaped surface of the lung. (d) Histo­
logical section of some of the radiating structures reveals fi­
brotic strands and neoplastic cells in their bases. The de\'C:I­
opment of this structural combination is discussed later 
(Chapters IX: Eand XVI: J). It depends on a mechanism 
which will be shown tO be responsib le also for the dc:\•c1op .. 
ment of so-called skin thickening in breast cancer. Malignant and be11igo neoplasms 37 The radiographic appearance of what is here named 
a retraction pocket is illustrated in Fig. Ill: 36. Posteroanterior (a) and lateral (b) projections show a 
squamous cell carcinoma in the left lung surrounded 
by a radiolucent "A" zone. Two funnel-shaped pleural 
densities are situated laterally, indicated by arrows in 
the posteroanterior view. Some linear tissue structures 
are also seen between the tumour and the funnel­
shaped structures. A computerized tomogram (c) 
shows that the two funnel-shaped structures connect 
with the pleura and point opposite two protrusions of 
the tumour. These pleural changes show the radiogra­
pruc appearance typical of retraction pockets. Retraction pockets are also illustrated (Fig. III: 37 a, 
b) near a moderately well differentiated adenocarcino­
ma. In this case, extremely thin radiating structures 
were not seen in the plain radiographs. The lung, 
slightly inflated in a postoperative radiograph (c), 
shows the thin radiating structures and the retracted 
lung tissue between the tumour and the pleura. In a 
histological section (d), some of the small radiating 
structures are seen. They contain some vessels and 
tumour cells close to the tumour mass. Far out in the 
lung parenchyma the radiating structures consist of 
onJy ufibrous" tissue. A preliminary explanation for the development of a 
retraction. pocket can now be proposed. Retracted lung tissue between a tumour and the 
pleura is often easily recognized. Fibrotic radiating 
structures from the surface of a tumour also are often 
easily recognized. It is well known that scar tissue 
shrinks sl·owly after its initial formation (I). This phe­
nomenon can most easily be explained as a process of 
dehydration of a material with hygroscopic properties. The radiating structures around carcinomas of both 
lung and breast often contain a mixture of different 
fibrotic materials . Some of these materials are also 
birefringent (I) and show different degrees of tortuo­
sity in relation to other adjacent fibrotic materials. The 
solubility in water of different fibrous tissues in the 
38 M.alignant and be.nign neoplasms body is known to vary considerably (1). For instance, 
the predominant material of tendons is collagen, which 
is insoluble in water, unlike other fibrotic tissues. Variations in the degree of stretclllng and relaxation of 
radiating structures may therefore be produced by 
variations of water content of different fibrous materi­
als. It will be shown in Chapter IX that the remaining 
prerequisite for local hygroscopic stretclllng and 
shrinking in radiating structur~local variations of 
their water content-is also present. Furthermore, it 
will be shown in Chapter XVI that the retraction 
pockets in the lung correspond to so-called skin thick­
ening and retraction of the skin in cancer of the breast. References 
I. Asthbury, W. T.: In: Mercer, E. M. (ed. ): Keratin and keratin· 
ization. New York, Pergamon Pr·ess, 1961, p. 255. 2. Cordier, G., Paparniltiades , M., and Ctdard, C.: Les lymphati· 
ques des brooc-hes et des segments pulmonaircs. Bronche 8:8, 
1958. 3. Dahlgren , S., and Nordtnstrom, B.: Transthoracic needle biop­
sy. Stockholm, Almqvist & Wikscll, 1966. 4. Kerley! P.: In: Sh.anks1 S. C., and Kedey, P. (~s. ): A text· 
book of X·ray diagnosis , 2nd ed!. London. Lewis, 1951, pp. 404, 414. S. Nordenstrom, B.: Transjugular :approach to the mediastinum 
for mediastinal needle biopsy. Invest. Radio!. 2: B4, 1967. 6. Nordcnstrom, B.: New trends and techniqun in roentac-n dia.g­
nosis of bronchial carcinoma. In: Simon, M., Potcben, E. J., 
and LeMay, M. (eds. ): Frontiers of pulmonary radiology. New 
York, Grune & Stratton, 1969, p. 380. 7. Remy, J.: Die Wichtigkeit der Bildqualitiit bei der Auswertung 
von Sc:hirmbildaufnahme n. In: Stieve, F.-E. (ed. ): BildgOte in 
der R.adiok>gie. Stungan, G. Fischer Verlag, 1966, p. 249. 8. Rigler, L. G.: The roe:ntgm signs of carcinoma of the lung. Amer. j. Roentgenol . 74:415, 1955. 9. Rigl-t-r, L. G.: The earliest roentgenographic: signs of carcinoma 
of the lung. JAMA 195:655, 1%6. 10. Rigler, L. G.: An oven·iew of cancer of the lung. Seminars in 
R~mgenol. 12:161, 1977. I 1. Stieve, F .·E. (ed. ): BildgOtc in der Radiologic . Srottgan, G. 
Fischer Verl-s, 1966, p. 3-80. 12. Trapnell, D. H.: The pe:ripherallympbatic:s of the tuns. Brit. J. Radio!. 36: 600, I %3. IV. Corona structures around 
inflammatory lesions, 
including those of silicosis 
Corona structures of different malignant and some 
benign neoplasms have thus far been presented. In 
fact, the author originally described a "corona rna­
ligna" (I) and believed! for years that the different 
radiologic signs reported here were observed only 
around malignant tumours. It was therefore of consid­
erable interest when a tuberculous granuloma was 
found which also showed several of the corona struc­
tures. This rather large tuberculoma, first observed in 
1967, is shown in Fig. IV: I a. Situated in the middle 
lobe of the right lung, it shows an "A" zone, racJjating 
structures, some lamellae and deviation of the ve.ssels 
in the surrounding lung parenchyma. Needle biopsies 
were performed on four different occasions beeause of 
the suspicion of malignancy . Neoplastic cells were 
never found. The biopsies revealed only necrotic mate­
rial and chronic inflammatory cells suggestive of a 
tuberculous granuloma. Chest racJjographs over an 8 
year period did not change. Tuberculin skin test was 
positive. The diagnosis of tuberculoma was actually 
presumed rather than absolutely proven, but the evi­
dence provides virtual certainty that the mass was 
inflammatory and not neoplastic. A pneumothorax , about 3 em broad, developed in 
1969 after one of the needle biopsies (Fig. IV: I b). The pleural space is open and the visceral pleura 
locally thickened. The lung is irregularly collapsed. The tuberculoma contains an air cavity and is sur­
rounded by an "A" zone. In contrast to observations 
of most malignant lung tumours, the "A" zone re­
mained almost unchanged in spite of partial collapse of 
the lung. An explanation of this phenomenon could be 
that this particular case represents a pathologic condi­
tion in the lung which has persisted relatively un­
changed over seven! years, resulting in a more or less 
permanent structural rearrangement of the tissue. Fig. IV: I c shows the lesion in 1971 when no air was 
present in the pleura. The cavity of the lesion had 
resorbed, to be replaced by a concavity in the supero­
lateral part of the lesion and the formation of a lamella 
in the adjacent pulmonary parenchyma. The radiolu­
cent "A" zone around the lesion is apparent. Vascular­
ity is possibly reduced in the "A" zone. A verified tuberculous granuloma is illustrated in 
Fig. IV: 2. Situated in the apical segment of the right 
lower lobe, this lesion shows an "A" zone, a uB" zone 
and some radiating structures. Irregular dense opacity 
is caused by pleural calcification , presumed to be unre­
lated to the corona changes. Corona structures can also be seen around a myce­
toma within a large central air-containing cavity (Fig. Inflammatory lesions 39 IV: 3). The lesion is surrounded by rather coarse radia­
ting structures and narrow irregular vessels, some of 
which are circularly displaced around the lesion 
(arrows). Finally, silicotic granulomas are illustrated in the 
right and left upper lobes (Fig. IV: 4a, b). Both shuw 
radiating structure-s and "A" and "B" zones. The d.iJTerent malignant and benign tumours in 
Chapter III and the various non-neoplast ic, inflamma­
tory lesions in this chapter all share several corona 
changes. The possibility of a common denominator 
behind these similarities wiU therefore be discussed in 
the following chapter. 40 Inflamm atory lesions Fig. N: /.Tuberculous granuloma, unchanged for 8 
years. Diagnosis also based on four separate aspiration 
needle biopsies. (a) Age46. An "A" zone, thin radiat­
ing structures, some lamellae and displacement ofves· 
scls arc evident around the lesion. (b) Two years later a 
pneumothorax was produced during a needle biopsy. The pleural space is free. The lesion t..-ontnins air.f'i11ed 
cavities. Note the persistent "A'' zone despite partial 
collapse of the lung. (c) After two more years, radiating 
structures and a radiolucent zone are apparent. The su· 
pcrolateral aspect of the lesion is now concave, indicat­
ing a partial collapse of this pOrtion. The lesion no long­
erappears cavitary. Vessels around the ·• A'' zone remain 
circularly displaced. A new lamella is seen in the lung 
close to the concave surface of the tuberculoma. Reference 
I. NordenstrOm, 8.: New m:-nds and technique:;, in TOCnlgen diag:· 
nosis of bronchial cartinoma.ln: Simon. M .• Potchen. E. j., :md 
Le May, M. (eds. ): FrontierS of pulmonar y radjology. New 
YorkJ Grune & Stratton, 1969, p. 380. F1g. I\': 2. Tuberculous granuloma in the ap1c.tl segment ol 
the riglu lowe, lobe in a 55·year-QJd man. ••A" anl.l .. tr' 
t.onc, are seen. Radiating structures arc= pre~ent . (al PO'-h:ru· 
an1crior, (b) 10" right posterior oblique and (c) ZO right All· 
tcrior obJjque projccrions. J ncidental pleural Ctll\:ifie1u ion 
cau~cs the irregular densities jnfcromcdial to lhc granull,ll'IU 
in a anu b. The calcification partially projects orcr the gran· 
uloma in c. 
Inflammatory lesions 41 Fig. IV: 3. 60-year-()ld woman. Myce1oma (Myoobac1erium 
Ill) of !he middle lobe showing central air-filled cavi1y and 
a 
B 
-'· ' 
~ 
Fig.IV:4. 70-year-old man.lithcouc granulomas in tne righ1 
(a) and lefl (b) upper lobes. Radiating struc!ures and "A" 
and "8" zones surround the lesions. 42 lnllammatory lesions radiating structures. The. surrounding lung parenchyma cor 
tains some narrow and circularly displaced vessels (arrows). v. 
Discussion of the radiological 
observations of corona 
structures 
The existence of corona structures around a variety of 
pulmonary neoplasm s and inflammatory lesions has 
bttn described in the previous two chapters. The 
morphologic and pathophysiologic background of 
these structural changes is in many ways confusing and 
may appear difficult to explain. No direct correlation has been found with the histo­
logical type or degree of cellular differentiation of the 
tumours. The structural changes-here called "A" 
and "Bn zones, arches and arcades, radiating struc­
tures, narrowing and displacement of vessels-may or 
may not be present in squamous cell carcinoma s, ade­
nocarcinomas , oat cell carcinomas or mixed cell carci­
nomas, in primary as well as in metastatic tumours. The structural changes have occasionally also bttn 
observed in the presence of different inflammatory 
lesions. Finally, wme of the changes have been ob­
served around hamartomas. The structures are often very delicate and therefore 
may be difficult to recognize. As discussed in Chapter 
II, special auemion is required for the technique of the 
radiographic examination. So-called "routine" frontal 
and lateral views of the lungs are not always sufficient 
for radiological identification and evaluation of the 
signs. The "B" zone around malignant tumours has been found to disappear whenever air is introduced into the 
pleural space. This evidence strongly suggests that the 
"B" zone is fluid, locally collected in the lung tissue, 
probably due to the mechanical blocking of lymphatic 
channels between the pleura peripheral to the mass 
and the hilar lymph nodes. Supporting this assump­
tion is the finding that it was possible to produce such 
a fluid collection in the lung in dogs after the place­
ment of an artificial "tumour" of plastic material in 
the pulmonary parenchyma. The experiments in dogs are equivalent to the situa­
tion in patients in regard to the mechanical effects of a 
real tumour or tumour-like lesion. A tumour in a 
patient may be expected to block the draining lympha­
tic channels between the pleura and the hilum, result­
ing in lymphatic stasis. Indeed, it would seem reason­
able to expect frequent local accumulation of fluid in 
the parenchyma peripheral to a pulmonary mass . Such 
a mechanism is also c.apable of explaining the disap­
pearance of the "B" zone in the dog experiments and 
in patients after some air is introduced into the pleural 
space. For these same reasons it can now also be 
understood that the "B" zone has not bttn observed 
in postoperative specimens examined by qualified 
pathologists. As soon as the mechanical conditions 
which exist in situ are changed, e.g., by the opening of 
Discussion of corona structures 43 the pleural space, some of !he prerequisites for the 
presence and demonstrat ion of local oedema ("B" 
zone) will disappear. A consequence of this discussion is also that a "B" 
zone pedpheral to a pulmonary cancer should not he 
misinterpreted as malignant extension to the pleura, 
local bronchopneumon ia, local pleural thickening or 
atelectasis. The "B" zone appears to be a harmless 
oedema and by no means a contraindication to opera­
tive removal of a tumour. Recognizing the radiographic signs which identify a 
"B" zone is of evident practical importance. The fol­
lowing radiographic signs should he looked for: 
I) A pulmonary opacity between a tumour or tu· 
mour-like lesion and the pleura. 2) Interposition of a radiolucent "A" zone between 
!he lesion and the zone of increased opacity. 3) A sharp borderline in the shape of small arches 
forming an arcade. 4) The outer contours of the opacity appearing ei­
ther to ""vanish diffusely" into the adjacent lung or to 
end in a well demarcated line shadow such as interlo­
bar pleura or an intrapulmonary septum. 5) The presence of enlarged interlobular spaces ex­
tending between a tumour and !he pleura. 6) Disappearance of the opacity after injection of air 
into the pleural space. Whenever an "A" zone c.an be seen between the 
surface of a mass and a peripheral , local increase in 
pulmonary opacity ("B" zone), neoplastic O\•ergrowth 
or ateleclasis can he excluded as possible causes of the 
"B" zone. It has been pointed out that a "B" zone, which 
means lymphoedema due to local stasis in the periph­
ery of the lung parenchyma, may he present in the 
absence Q{ a defmite "A" zone. In th_is situation, the 
only abs<>lutcly conclusive proof of the presence of a 
"B" zone is the sign of disappearance of !he "B" zone 
lymphoedema after injection of air into the pleural 
space. Tbe explanation, however, that "B" zones are 
caused by local pulmonary oedema docs not entirely 
explain lheir location. Between the pleura, the "B" 
zone, and the blocking lesion, an "A" zone may be 
interpositioned, which also needs explanation. Olher signs requiring explanation are !he formation 
of arches and arcades at the interface between the "A" 
and uB"' zones, the existence of radiating structures, 
and !he observed narrowing and displacement of ves­
sels in the lung parenchyma near a pulmonar y lesion. These vascular changes may seem difficult to under­
stand, and can he tied to some earlier observations in 
this field. In 1946 and 1951 Marchal and Marchal (3, 4) re­
ported diminished pulsations in the lung parenchyma 
around malignant tumours. They made this important 
observation by means of direct fluoroscopy with a 
44 D.iscussion of corona structures photocell between the subject and the screen. They 
considered lhese diminished pulsations to he a sign of 
malignancy . The observations of decreased pulsations 
around the tumours are in agreement with the author's 
observations of a decrease in calibre and irregular 
contours of the pulmonar y vessels around the tu­
mours. Roentgen densitometry was also applied by the au­
thor in 1954 (5, 6) in studying the elTecls of balloon 
occlusion of pulmonary arteries. These studies showed 
that the occlusion of a central pulmonary artery causes 
a considerable decrease in calibre of the pulmonary 
vessels and a decrease in !he blood pressure and blood 
volume in the lung distal to the occlusion. Bronchial 
arterial blood then shu.nts into the occluded pulmo­
nary arterial branches distal to the level of obstruction. These branches then contain blood of higher arterial 
oxygen saturation than simultaneously obtained sys­
temic arterial blood. The presence of such arterial 
blood in a pulmonary anery should, according to the 
well known experiments by von Euler and Liljestrand 
(2), cause local vasoconstriction. It should also he 
noted that in studying specimens of lung tumours, we 
have found (I) that thrombosi s is often found in the 
vessels around malignant tumours. From !his discussion it is evident !hat several factors 
may be responsible fo·r !he radiologically observed 
structural changes (corona changes). Because these 
changes are very often seen together, it is likely that 
they depend on one or ·several common factors which 
are present under cenain conditions. The examples of inflammatory lesions as well as 
neoplasms may allow us to conclude that "A" and 
"!l" wnes, radiating stntc!ures, arcac:!es, lamellae, de­
viations and narrowings of adjacent vessels are by no 
means specific to the histologic type of lung tumour. These structures can hoc found in association with a 
wide variety of benign and malignant tumours as well 
as with different tumour-like inflammatory lesions 
such as granulomas. This finding does not mean that the reported radio­
logic signs are not specific. In fact, as will be seen, 
they are actually a very specific manifestation of a 
constellation of biokinetic and mechanica l events 
which may occur in sc\~cral pathological conditions in 
the lung (as well as in other organs). These events will 
further be discussed as they occur in experimental 
models. Next it is appropriate to turn to some of !he 
electrical properties of lhe lung and pleura. Reference s 
1. Dahlgre-n, S., and NordenstrOm, B.: Tnnsthoracic needle biop­
sy. Stockholm, Almqvi.st & Wiksell, 1966. 2. von EuJer, U. S., and Liljestrand, G.: Observations on the pulmonary anc-rial blood pre-ssure' in the <:at. Acta Ph)'tiol. Scand, 12:301, 1946, 
3. Marchal, M. M..: De l't-nregistre.ment des pulsations in\'isibles du 
parenchyme pulmonaire ainsi que des pulsations cardio\'ascu4 
laires par Ia cinedens.igraphie . Arch. Mal. du Coeur 39:345, 
19~, 
4. Marchal, M. M,, and Marchal, M. T.: Nouvelle methode de cini-densigraphie Ctalonnee permcttant le diagnostic differc:ntiel 
du cancer du poumon. Comptts rendus des seances de l'Acade· 
mie des Scic:n<::es 233: 458, 1951. 5. NordenstrOm, B.: Temporary unilateral occlusion of the pulmo­
nary anery, Acta Radio!. SuppL 108, 1954, 
6. Nordenstri!lm, 8.: Pulmonary circulation time:. Acta Radial. 41:209, 1954, 
Discussion of corona structures 45 VI. Electric potentials in 
nonnal lung, pleura and liver 
and in focal pulmonary lesions, 
including bronchogenic 
• carcmoma 
A. Preliminar y studies 
1. Introduction 
The possibility that pulmonary tumours sometimes 
may polarize electrochemica lly in relation to surround­
ing tissue is investigated in this chapter. The variety of pathological conditions in which the 
described radiological signs have been found suggests 
that the signs are dependent on some common factors. Internal bleeding and necrosis, for instance, must be 
considered as phenomena common to various neo­
plasms and tumour-like inflammatory lesions. Autolysis characterizes necrosis. Cellular elements 
are destroyed. Molecules are split. The result is entire­
ly new physical and chemical conditions in the in­
volved regions. Their relation to the surrounding tis­
sues have here beeo studied by means of electrophysio­
logical techniques . This chapter describes a study of electric potentials 
of the lung and pleura in 27 dogs and in 119 patients 
with various pulmonary lesions. Supplementary ex­
perimental studies on electric potential of the liver and 
the effect of short circuiting subcutis (15 dogs and 3 
rabbits) are also included. This latter part of the study 
was carried out to facilitate the evaluation of possible 
influences of reference tissues. 46 Electric potentials 2. Procedures 
An obstacle in the studies of patients was to obtain 
permission to introduce electrodes for the measure­
ments. For ethical reasons the procedures had to be 
carried out as a comprom ise between the generally 
accepted techniques of needle biopsy for cytologic 
diagnosis and optimal techniques for measuring elec­
tric potentials. In a first series, polarizable metal elec­
trodes were used and in a second series non polarizable 
Ag-AgCI electrodes in KCI bridges. Stainless steel electrodes for the measuring of bio­
electrical events have been used by Grundfest, et al. (6). They developed stainkss steel microelectrodes by 
mechanical sharpening and electropointing. Careful 
analyses of the electrical properties of different metal 
electrodes have been performed by Weinman and 
Mahler ( 19) and of stainless steel electrodes by Ged­
des, eta!. (5). The advantages and limitations of stain­
less steel electrodes are therefore well known. The technique of percutaneous transthoracic needle 
biopsy for sampling of cellular material from the lung 
is now well established (3, 10, II) and accepted in 
many instirutions as a routine procedure in selected 
patiems. The diameter of the stainless steel biopsy needles is 
0.9-1.0 mm. Their length is 16 em. Nonpolarizing electrodes, however, with these dimensions and a com· 
bined capability to sample cytologic material for dini· 
cal diagnosis could not be obtained. Stainless steel 
biopsy needles were modified so as to become elec· 
trodcs for preliminary measurements of mixed electric 
potentials in the lung. The needles were coated with 
an insulating layer of Teflon, 0.1 mm thick. Despite 
the fact that increasing needle thickness is accompa· 
nied by an increased likelihood of complications, 
mainly pneumothorax , this very slight increase in 
thickness of the needles was considered acceptable. The insulation at the tip of each needle was scratched 
off so the steel could make contact with the tissue. The 
needles were in the preliminary series connected to an 
electrocardiographic amplifier. Later, nonpolarizab lc 
electrodes were used connected to a DC amplifyer 
(Grass Polygraph ). Electric potentials were then measured between a 
grounded subcutaneous reference electrode, also of 
stainless steel, and the exploring electrode, inserted 
percutaneous ly under local anaesthesia and fluorosco· 
pic control into the lung (8). The exploring electrode 
was moved manually as evenly as possible from the 
Fig. VI: I. Absence of sig­
nificant potential difference 
between lumour and sur­
roundjng lung. Poorly dif­
ferentiated squamous cell 
carcinoma in the left lower 
lobe of a SS-year-old wom­
an. On insertion of I he nee~ 
die electrode into the tu· 
mour (In ant), as it lay with· 
in (Centre) and as it passed 
through the posterior wall 
(Post), only small irregular 
de nee liOnS o( Cht: electric 
potential and regular electric 
fluctuations from the hear! were recorded (upper trac­
ing). On withdrawal of the 
electrode (bonom cracittg), 
similar small defleclion s 
were recorded from the pos· 
tcrior wall of the mass (Om 
post), in the centre (Centr) 
and from the anterior wall 
(Ant). [ 1 mV In ant chest waU through the lung tissue into the actual 
lesion. The electric potential difference was traced 
continuously. CeUular material from the lesion was 
aspirated by attaching a syringe to the hub of the 
needle-ele ctrode. Several insertions were usually made 
through the waUs of the lesion in order to check the 
reliability of the tracings and to sample representative 
cel.lular material. After a series of 22 normal dog experiments, it was 
found that a reproducible tissue proftle of electric 
potentials of the normal lung of the dog could be 
rather easily identified with this technique. With this 
background, a preliminary study on patients was be· 
gun. 3. Case material 
Electric potentials of pulmonary lesions were mea­
sured in 107 patients. The groups shown in Table Vl: I were studied, the 
verification being based on cytologic, bacteriologic and 
postoperative histologic examinati ons. Centre Post 
Centre Ant 
Electric potentials 47 Table VI: I 
&,nig.n tumours (neurilemmoma 3, C)'Sts 2) 
Inflammatory les-ions (pleuroma 3. tuberculoma 9, 
fibrous tuberculous tissue It, chronic non­
specific inflammation II. m)'cetoma 2) 
Meta-stase s 
Bronchogenic carcinomas 
Diagnosis not proved 
4. Results !6 
12 
t7 
7 
(a) Repeated insertion and removal of the exploring 
electrode revealed a spatial panern of potential, the 
"eltttric potential proflle of tissue", usually reproduc ­
ible for each lesion. (b) Malignant tumours of similar size, location and 
histological type may show completely different pat­
terns of electric potential. For example, Figs. VI: I and 2 show the radio­
graphs and tracings of potential from two poorly dif­
ferentiated squamous cell carcinomas, each 4 x 5 em in 
In ant Centre 
[1mV 
c 
l size (frontal projection), located in the left and right 
lower lobes, respectively, of two different patients. The left-sided tumour (Fig. VI: I) showed no defi· 
n.ite or reproducible changes of potential at its surfaces 
or inside the mass in comparison with the adjacent 
pulmonary parenchyma. The right-sided tumour (Fig. VI: 2) showed a very 
distinctly positive surface potential. The upper curve 
shows the tracing on a single slow insertion and reJrac­
tion of the electrode. The lower curve shows repeated 
insertions and retractions, performed about three 
times more rapidly. 1 The bonom tracing shows the 
exposure markings (Exp) during simultaneous cinera­
diography (50 frames/sec ) with the roentgen beam 
perpendicular to the axis of the needle-electrode. A 
rough correlation could be obtained in this way be­
tween the positions of the electrode point in the tissue 
' The repeated insertion of the needle is pan of an acceptN tech· 
nique for aspiration biopsy (3). A$ continuous negari\'c pres~rJre is 
applied in the needJe, repeated insertions lhrou.g.b me tumour sur· 
fat. 't'" produce a packing of pot'cntially diagnostic cells into the needJe 
from different pans of the tumour. The tracings of electrtc potential 
and the sampling of cell material were, however, made stpantel y. Out -
Exp 
l~llllillll,;,~ll!llllli ii:IiiiAIWiill~~!illlllllllb1 iilmm!II:'Jili~Jji\ll ~.i!IIKIIIIIi lilM~IIIIN1HII\I';Q!IIIIil\llli!!ll! !l!llli!I!IIIU~i\HiiHlK illilil!\lll Fig. VI: 2. Electropositive 
tumour in lung. Poorly 
differentiated squamous 
cell carcinoma in rhe right 
lower lobe of a 74-year-old 
man. Positive electric po· 
tential was obtained in re· 
lation to surround ing lung 
tissue as the elecrrode en· 
tered the tumour (In ant}, 
lay within it (Centre), and 
was removed (Out). These 
findings were constant 
both on one slow inserrion 
and retraction of the elec­
trode (top tracing) as well 
as on more rapid andre­
peated manoeuvres (mid­
dle tracing). C = inside 
the tumour; L = lung. Bottom tracing shows ex· 
posure markings at cinera· 
diography (frame frequen· 
cy, 50/sec) for the identifi· 
cation of the electrode tip 
in the tissues and its corre· 
lation with tht tracings of 
potential. 48 Electric potentials Centre Fig. VI: 3. Electronegative tu­
mour in lung. Metastatic me· 
lanosarcoma in the right up­
per lobe of a 57-year-old wom­
an. Internal necrosis was 
found on aspiration of cellular 
material. A negative potential 
was presem ins-ide the rumour 
compared with the surround­
ing Jung tissue, shown upOn 
slow anterior insertion (In 
ant) and further passage 
through posterior wall (In 
post} of the exploring elec­
trode (top tracing continues in 
1he middle uacing). The same 
profiles of tissue potentia] 
were obtained upon more rap­
id, repeated insertions and re­
tractions of the electrode (bot­
tOm tracing). [1mV 
Centre In post 
~r--',..--..y--~r--tc::y:;.--
Out ant ~ 
and the different parts of each tracing of electric po­
tentiaL 
(c) Regions of damaged tissue showed locally nega­
tive or positive potentials in relation to the surround­
ing lung tissue. This correlation was obtained by samp­
ling the cells of these regions through the needle 
electrode . In fact, this finding appeared to be useful in 
the selection of suitable sites for biopsy_ When the 
combined biopsy electrode -needle was inserted into a 
tissue in which potentia) was negative or positive, as 
compared with the surrounding tissue, the sampled 
cell material was usuaJJy necrotic and therefore cytolo­
gically nondiagnostic. Such a case is illustrated in Fig. VI: 3, which shows 
a large metastatic melanosarcoma in the right upper 
lobe. It appeared to be extensively necrotic on needle In ant ~ Out ant 
~ 
aspiration biopsies from five sites. The electric poten­
tial profile of the tissue showed small but distinctly 
negative deflections inside the tumour compared to 
surrounding lung tissue. One slow insertion to the 
centre of the tumour and out through the posterior 
wall is seen in the top :~nd middle tracings in Fig. VI: 3. Repeated insertions and retractions of the elec­
trode through the anterior wall of the tumour are 
shown in the bottom tracing. (tf) Negative surface potentials and elevated internal 
potentials were also encountered in malignant tu­
mours. A similar type of electric potential profile of 
tissue was also encountered in local infections. (e) A positive surface potential and negativP internal 
potential were also observed in granulomas. A tuber­
culous granuloma, for example, is seen in postcro-
Electric potentials 49 Lung In ant 
1mV ('1 .__.:.;;. ;,:___ ______ _/1 
Centre )o Out ant ,_ 
In ant Centre Out ant 
50 Electric potentials Fig. VI: S. Electric potential 
between inflammatOry le­
sion in the lingula and sur· 
rounding lung in a 50-year­
old man. A negative potcn· 
tial w11s obtained at the pe­
riphery of the lesion, and a 
positi \'C potential inside the 
lesion as the exploring elec­
trode entered the lesion and 
then \\'3S retracted into the 
lung parenchyma. [ 1mv 
anterior and lateral views in Fig. VI: 4a and b. Vessels 
around the lesion appear circularly displaced. Fig. VI: 4t and d show the needle electrode inside the 
lesion. Positive fluctuations of potential were seen 
when the needle-electrode entered the lesion. The 
positive surface potential was then followed by a deep­
ly negative potential inside the mass. When the elec­
trode was retracted from the centre to the surface of 
the lesion, a new positive potential deflection appe.ared 
(middle tracing). When these two manoeuvres were 
combined rapidly (bonom tracing), i.e., insertion to 
the centre and immediate retraction , a combination of 
the tOp and middle tracings was obtained. A "reversed" profile of tissue potential was also 
~ Fig. V/:4. Electropositive surface potential of a tuberculoma 
in relation to surrounding lung tissue. Righi upper lobe of a 
42-year-old woman: (a) posteroanterior and (b) lateral views, 
(c) and (d) biop!ly electrode in lesion. When tbe electrode en­
tered the lesion (top tracing, In ant) a positive surface potcn· 
tial was observed. Upon retracting the electrode from the 
centre of the Jesion into lung anterior to it (middle tracing, 
Out ant), a new positive potential was obtained. Upon rein· 
setting the electrode into the lesion and immediate pulling it 
back into the lung parenchyma , a summation of the individ· 
ual top and middle tracings was obtained (bottom tracing). observed occasionally, as in the nonspecific inflamma ­
tory lesion seen in Fig. VI: 5. As the needle electrode 
was inserted and then retracted , the corresponding 
tracing showed a negative deflection with the "explor­
ing" electrode at the periphery and a positive with the 
electrode inside the tumour. The inflammatory lesion 
seen in Fig. VI: 6 also gave rather consistently small 
negative deflections of potential when the needle elec­
trode was passed through its anterior and posterior 
margins, as shown in the three tracings. (j) Both malignant tumours and inflammatory le­
sions showed, to a large extent, similar types of pro­
lilt'S of electric tissue potential. They also showed 
considerable variation among individual patients, al· 
though each lesion revealed a consistent pattern of 
fluctuations of potential on repeated tracings. The magnitude of the differences of potential could 
never be predicted beforehand. In 20 (19%) of the 107 
cases, positive or negative potential differences exceed­
ed IZ mV, c.ompared with surrounding normal tissue. In eleven cases (10%), potentials of 30 to 50 mV were 
observed. No sigrtificant potential difference was 
found in 20 cases. In 56 cases the potential profile of 
tissue showed multiple small positive and negative 
deflections. The variability of the different types of potential 
Electric potentials 51 In ant In POSt 
--~-------------~~---------------~ 
[t mV In ant In post _.;._ __ ___: ~ Fig. V/:6. Slightly negative 
electric potential inside a 
nonspecific pulmonary in· 
Oarnmatory lesion in a 58· 
year·old man. Each of the 
three tracings depicts an 
electronegative lesion, t"''m· 
pared to surrounding lung. ------~-~~~¥---------- -----
In ant In post 
differences illustrated above appeared initially to be 
unexplainable. The reproducibility of the fluctuations 
of the tissue potential in the individual cases indicates, 
however, that specific differences of electric potential 
do sometimes exist between lesions in the lung and 
surrounding tissue. No attempts have been made thus 
far to determine "absolute values" of such potential 
differences because their functional effects, in terms of 
flow of electric current (a main topic of this book), 
depend not only nn the generation of potential gradi· 
ent but also on the character istics of existing circuitries 
and times of current flow. As will be seen in later chapters, electric polarization 
of tissues, giving rise to electric transports, fits into a 
logical explanation for the development of structures 
and various functions. Before reporting these srud.ies, however, we should 
briefly discuss possible sources of local polarization of 
tissue. Local changes of the physicochemical potential, 
e.g., at the surface and inside a lesion as compared 
with surrounding normal tissue, can be expected to 
develop in two principal ways: (a) by the "normal" 
52 Electric potenti.als metabolism of the actual pathologic process, or (b) 
additionally, by a "complicating" pathologic process, 
i.e., local necrosis, bleeding or infection. In the case of "normal" pathologic metabolism, 
tissue-specific physicochemical potentials might be ex· 
pected. The electric potential, however, appears most 
unlikely to permit differential diagnosis of normal and 
pathologic tissues. In the case of a degrading process in a normal tissue 
or tumour, the total physicochemical potential can be 
expected to change as an injury potential. In this view 
it is understandable why tissues such as malignant 
tumours very often, but not always, show electric 
polarization as a consequence of the internal bleedings 
or local necrosis common to neoplastic tissues. The 
"accidental " local development of necrosis, bleeding, 
infection or similar factors is probably the most likely 
background for the development oflocal electrochemi · 
cal changes in malignant tumours. To investigate the accumulation of local charge, 
e.g., at the surface of certain lesions, the local effects 
of short circuiting of normal tissue were assessed. Studies were perfonncd first in normal subcutaneous 
tissue of the dog, then in human pulmonary masses 
found to have an elevated electric surface potemial in 
relation to surround ing nonnal tissue. Finally, experi· 
ments were performed to charge and discharge tissues. B. Short circuiting of 
different parts of normal 
subcutaneous tissue 
The possible influences of local differences of charge 
in tissues require some considerations of the character­
istics of colloids. When in aqueous suspension of low ionic concentra­
tion, p•a~lkaJJy aU Ull(ani<. : auU iuorganh. : l:olluills an: 
electronegative in the pH range of 5 to 10 ( 14). The 
zer.a potential in such systems (see also Fig. X: 8) 
varies generally between -14 to -34 mV. Proteins 
with zeta potential values less negative than -14 m V 
are usually unstable. Stability characteristics of col­
loids are prescmed in Table VI: 2 as a function of their 
zeta potentials, according to Riddick (14). a Table Yl:l 
Stabiliry characteristics 
Maxim~.m agglomeration and precipitation 
Range of strong agglomeration and 
precipitation 
Threshdd of aggJomera tion 
Thrcshdd of deJjcate dispersion 
Modera!C stabilit)• 
Fairly good stabilit)' 
Very good stabi1ity 
Extremely good stabiJhy Average-zeta 
potential 
(millivolts) 
Oto +3 
+5 to -5 
-IOto -IS 
-16to -30 
-31 tO -40 
-41 tO -60 
-61 tO -80 
-81 tO -100 
Proteins of living tissue also fall into these catego­
ries, although as pH decreases they become less elec­
tronegative. Even the average level of electric potential 
of living tissue maintains a net negative charge, usually 
well below the threshold values for colloid agglomer­
ation and pl'ecipiliHivu (14). Witlllu e~ Li:s:sue, h::vd:s uf 
electric potential can be expected to vary. Hypotbeti · 
cally, then, experimental levelling of the densities of 
ionic cllargc among different regions of a tissue should 
be expected tO alter the normal electrochemica l envi­
ronment and most likely interfere with usual tissue 
functions . This hypothesis was tested in the subcutis 
of three normal dogs in the following way: 
. . . . .n ... I 
.I. f ;. ~: . . . . . .. 
Jf • • 
b Tissue I 
Tissuell ------.... ----· 
:1 
Tissue 
potential 0-. '<-----,-- --- -.,..-.,..---.,- ---~ .... Ground I 
Tail Fig. VI: 7. Shon circuiting 
of different parts of the sub· 
cutis of a dog. (a) The right 
side of a dog was shaved and 
a regular pattern of ink dots 
were placed on the skin. (b) 
Two regions of tissue of dif­
ferent potential (I and II) 
were connected with each 
other by an external wire 
(over ground). The t.-onduct­
ing electrolytes in the inter­
taitinl fluid complete G 
closed circuit, aJiowing a 
levelling of the assumed dif· 
rerenccs of tissue potential. The resultant levelling is re­
corded as changes in the lo­
cal electric potential under 
each dot in relation to a dis­
tant, grounded reference tis­
sue (subcutis of the tail). Electric potentials 53 Table VI: 3. Deflectiom of potential (in mV, numcical/y negative) in the subcutis of the dqg pictured in Figs. VI: 7 and 8 
Grounded .sitt'S of shore circuit of the subcutis are indicated by X. For explanation , sec text 
52 52 46 •6 •5 ca 48 50 so 52 52 50 48 45 45 so 44 48 42 u so )8 ')$ }2 )2 }8 JO 24 40 20 X 
x 05 12 '' 20 zo 1a 22 2• zs 25 2s 2• 22 10 ,., 2<1 n 22 n zs 2• 25 2• 26 1a 25 24 22 2s 24 
12 }0 }() 28 }0 28 28 )0 30 28 26 )0 ~ 52 '52 }() '50 28 ~0 2S 22 24 24 25 24 26 24 U ~ 16 
15 20 18 22 ?4 24 28 28 30 }0 }0 29 28 }5 }8 J$ )4 }4 )2 }0 '5 }6 32 }0 }2 }2 42 )8 ')4 }8 
1~ 40 ~~ 10 ~~ 10 1e ze 10 11 ze l4 JO J1 Jj Je 40 40 JU 'e •o 41 •a 
Each animal was anaesthetised with an intravenous 
injection of sodium pentobarbital. One side of the 
chest and abdomen was shaved. 275 to 300 dots were 
made with ink to form comers of squares 2 em apart 
all over the shaved skin (Fig. VI: 7 a). Different parts 
of the subcutis were then connected to each other over 
a common ground (Fig. VI: 7 b). The electric potential 
of the subcutis correspon ding to each of the ink dots 
was then determined versus a distant grounded refer­
ence electrode in th.e animal's tail. Electrodes of mechanically stable steel were used to 
permit perforation of the skin. The potential differ-
54 Electric potentials ence between each measuring point and the reference 
electrode was determined with a Brush DC-potential 
instrument (Mark 220, input impedance 10 meg­
ohms). One examiner inserted the exploring elec­
trode while the numerical readings of the potential 
differences were read and noted by assisting examin­
ers. Insertions of the electrode were made in a trans­
verse scanning mode at each of the skin dots. Care was 
taken to introduce the exploring electrode into the 
space between the subcutis and the fascia of underly­
ing muscle, without entering the muscles. This place­
ment was most easily achieved by a slight lifting of the 
Fig. V/:8. Three-dimen­
sional display of electric po­
tentials in the subcutis of a 
dog, as represented by cor­
responding lengths of hang­
ing white strings. The upper 
ends of the strings represent 
zero, so that each individual 
tracing in the experiment re­
presents a negath•e value in 
comparison to the reference 
electrode. Fig. a shows a 
longitudinal view and b ace­
phaled view, which means 
the short side of the display 
of strings. Two sites of the 
subcutis were short circuited 
(indicated by X, in Table 
VI: 3). As seen in b, a "tun­
nel" of low values of poten­
tial is presenr berween the 
two shon circuited sites. Table VI: 4. Deflecrions of potential (in mV, numerically negatiw) in the second parr of the experiment iro the subcutis of the dog in 
Figs. VI: 7 and 9 
Grounded shon circuit sitts of lhe subcutis arc indicated by X. For explanation, see text 
X X 
40 J8 )6 28 )8 46 «$ 46 .45 ,._, 35 }0 45 }2 }2 H 42 46 50 50 52 50 50 60 60 
2"8 40 ')6 H JO JS 40 41.\ 46 40 '56 '55 )2 42 )0 JO 42 4$ 47 '>; ?S SS SO SS 60 60 
42 2'8 40 40 }(l }0 l8 40 45 42 JB 40 '52 35 38 '\0 36 40 4) 42 SO 50 55 50 55 55 70 55 
H co JO co •o 'JoO :52 •o J& •a c2 •o co 32 '2 A2 26 ,a 42 •6 «2 ;; so; 50 so 60 so 10 52 
41 «2 H JB 40 J<> 30 l6 40 50 t2 40 40 :SS 'S6 H 26 '5'5 40 40 42 60 5'5 50 50 55 50 '10 55 
50 42 JS •O 40 '50 }2 'S )8 46 >0 40 40 ~5 35 40 24 )6 V\ .t2 40 60 55 52 50 60 55 65 55 
42 40 42 40 2';8 }0 30 40 40 48 42 40 ~2 l$ 40 20 40 }6 40 40 60 75 70 
X 
skin as the needle electrode was introduced. The read­
ings were made immediately on entrance of the elec­
trode into the subcutis. The sites of tracings of poten­
tial and their corresponding reaclings were correlated 
at the conclusion of each experiment. In the dog seen in Fig. VI: 7 a, points in the subcutis 
of the right shoulder and hind leg were short circuited 
over ground for 30 minutes. Measurement s of poten­
tial were then made during the following 20 minutes of 
Fig. V/:9. Three-dimen­
sional display of electric 1»­
tentials of the subcutis in the 
second part of the experi­
ment on the dog in Fig. VI: 7a. Fig. a represents a 
longimdin.al view and b a ce­
phaled view. For the pre­
vious 30 minutes, two short 
circuits of the subcutis were: 
made perpcndic:uJar to the 
short circuiting represented 
in Fig. VI: 8. The positions 
of the short circuited sites 
are indicated in Table VI: 4 
by X markings. Two new 
"tunnels" (a) of low poten­
tials are present berween th.e 
rwo pairs of short circuiting 
sites. For explanation , see 
text. X 
continued short circuiting between each of 276 record­
ing sites and the reference electrode . After the numeri­
cal tracings were recorded (Table VI: 3), they were 
displayed as three-dimensional histograms (Fig. VI: 8). Each histogram w:as made simply by colouring pieces 
of white wool strings with dark ink so that the unco­
loured parts corresponded to the actual readings of 
potential. The strings were then hung in a pattern 
corresponding to the sites and values of each reading. Electric potentials 55 Table VI; 5. Dejlecrions of potential (in xega1ive mV, except as indicated by a + sign) when many groundtd sites were slton circuited 
in the subcutis <>Ver the urea of shaved skm 
Same dog as pictured in Figs.. VI: 7 and 10. For runher discussion, see ttxt 
10 12 10 • 2 I •5 •• •I 
10 10 • 10 8 s 2 0 •• ., 2 
8 • 10 12 s • • 10 • • • 5 •• •> 0 
• 10 10 12 • 10 s • • • • • •• •> 0 
• 10 • 12 10 10 • • • • • s 0 0 0 
• 10 10 12 10 • • 2 8 •• 2 0 2 0 
12 • 10 10 10 10 • 2 10 ·• • 0 
20 5 18 10 10 12 8 • •• 2 
IS s 8 8 10 •• • • 0 0 
s • • 0 0 s 0 0 
10 5 0 •• • •I 0 
The three-dimensional display of !he readings is rhen 
seen in rwo photographs taken at right angles (Fig. VI: 8). The distribution and magnitude of the numeri· 
cal values represent negative millivolts. The electrical· 
Jy short circuited sites of 1he subcutis are indicated by 
(X) in Table VI: 3. A "tunnel" of relatively less nega· 
tive values of pOtential than in the surrounding subcu· 
ris was found to bridge the two ekctrically connecled 
sites (..\') in the subcutis. A second part of the experime nt was performed one 
hour after the previous short circuil connections had 
been removed. Four new sites in the subcutis were 
grounded, two amcriorly and rwo pOSieriorly along the 
Fig. VI: 10. Three-dimensional display of electric p01entials 
to dog subcutis after shor• circuiLing of Lhe subcutis across 
many sites. Polentials were measured btrween the exploring 
electrode and a grounded subcuraneous refe.rence electrode 
(jn Lhe tail). As seen in Table VI: 5, very small negaLivc and 
56 Electric potentials ~5 ~ 14 ·2 ·2 2 0 0 0 •2 1 • •• 0 
•• ... •• • I 0 •• 0 2 •2 0 • I ·2 0 
.. ·2 . ' ·2 ~ 0 0 0 •• 0 • > • • • 0 
0 •• •• •2 0 0 0 2 •5 • ' 0 0 
10 •> •• •l 0 I •2 0 •• 5 • 0 
•• •5 •• •l 2 0 •2 5 •• 0 • 
•• ·• ·• •5 •• 0 2 +4 +10 • • 12 20 • ,, •> 0 ., 0 0 0 ·2 ·2 8 5 12 5 
•l •8 ·8 •• 0 0 •• 0 ·> B +10 12 15 
•7 •9 •7 •• •2 ·2 •8 2 •• 4 +10 10 
+1 +10 ., •• ., t8 ~12 •5 0 
mid pOrtion of the long side of the examination area. The short circuit was again maintained for 30 minutes. Thereafter, the electric pOICmial was measured be· 
tween each of 1he 276 si1es and 1he reference electrode , 
as above. The results of this part of 1he experiment are 
seen in Fig. VI: 9, while the correspOnding numerical 
values of pOtential and sires of grounded short circuit 
connections appear in Table VI:4. Two new "runnels" 
Qf )Qwcred negative values of pOiential have appeared 
somewhat obliquely across the middle of the area of 
examination, correspOnding to the regions between the 
sires of the short circuits. A third pan of the experiment on the same dog was 
even positive potentials were ob1a.ined. The zero level is here 
indicated by small pieces of while plastic rubi.ng. Fig. a re· 
presems a view of the long and b a view of the short side of 
the display of s1rings. performed after additional short circuiting of the sub­
cutis across many sites (Fig. VI: 10, Table VI: 5). In 
this situation the potential differences were found to 
be either slightly negative or even positive. In the 
display seen in Fig. VI: I 0 the zero level is represented 
by small pieces of plastic tubing on the strings. At 
autopsy, examination of the subcutis revealed only a 
few minor blood stains but no large haemorrhages. Similar results of the three parts of the experiment 
were also found in the two other dogs tested. The experimental results in these 3 dogs indicate 
that the average level of potential of normal subcutis 
may be changed by external short circuiting of two or 
more regions of the tissue. The effects of such a 
measure are mostly regional and localized, as might be 
expected, to the tissue most immediately between the 
electrodes. As illustrated in Figs. VI: 8 and VI: 9, 
which were performed in the same animal, a recovery 
of the levels of potential took place between the first 
two parts of the experiments . This capability shows 
that the produced changes may be reversible. These effects on subcutaneou s electric potentials 
indicate that electrical transport developed preferen­
tially in the tissue between the short circuited elec­
trodes. This difference of potential then appeared to 
tend to equalize after 30 minutes in a closed circuit. A 
change of the distribution of electrical charges between 
dc:.,;Lrud.t:~ {. ;an thcn::fure be autldpalcd tu iuOucm. :c 
function of the tissues near the electrodes , resulting in 
a change in an electropositive direction of electronega­
tive potentials between the electrodes. This finding 
may be regarded as an interference with the electrone­
gative potential normally generated physiologically in 
the tissue. In Chapter XVIII, these experimental re­
sults will be utilized to explain acupuncture. C. Induced levelling of 
the electric potential 
of pulmonary lesions 
When an exploring nonpolarizable Ag-AgCI electrode 
or polarizable metal electrode is moved through the 
lung into a focal lesion, reproducible profiles of elec­
tric potential are usually obtained in relation to a 
grounded reference electrode in the subcutis. Imped­
ance of the recording instrument must be sufficiently 
high, (>10 megohms. See also Fig. XIII:9). When a recording instrument of "low" impedance 
(e.g., 1-2 megohm) is used, current can be demon­
strated to leak through the instrument, thereby dimin­
ishing the pOtential difference of the tissues. Fig. VI: II shows such a tracing of pOtenti21 while the 
exploring electrode touched many times against the Fig. VI: II. Local discharge of a bronchogeniccarcinoma 
with elevated surface potential in relation to surrounding 
lung over a low impedance (2 megohm) voltmeter. Grounded 
reference electrode in the subcutis. The tip of an exploring 
electtode was moved repeatedly against the surface of the tu­
mour. The surface potential of the tumour was initially ele­
vated but proeressively decreased as current leaked throu2h 
the recording instrument. surface of a bronchogenic carcinoma which had an 
elevated surface potential. The grounded reference 
electrode was positioned subcutaneously about 25 em 
from the lesion. Large deflections of potential are seen 
on the left side of the tracing at the beginning . The 
amplitudes of the deflections then diminish, as seen on 
the right side of the tracing. A similar experiment in tracing the profile of electric 
potential in tissue is illustrated in Fig. VI: 12, when 
picking movement s were made with the exploring 
electrode against different parts of the surface of a 
tuberculous granuloma. Large fluctuations of the elec­
tric potential were seen initially at various parts of Lin: 
surface of the lesion (top tracing). During a second 
series of picking movement s of the electrode against 
the surface (bollom tracing, left) and then a third 
series of picking movements (bouom tracing, right), 
the average amplitude of the deflections decreased . The lowering of amplitudes was larger between the 
first and second than between the second and third 
series of picking movements. An experimental analogue to this study will be pre-
Fig. VI: 12. Local discharge of a tuberculous granuloma 
with elevated surface potential in relation to surrounding 
lung. Grounded reference electrode in the subcutis. Repeat­
ed contact of the tip of the exploring electrode against the 
surface of the granuloma showed initially large potential dif­
ferences (upper tracing). Later, these difiTerences diminish­
ed in amplitude (on left and right oCiower tracing). For fur­
ther discussion, see text. ~ I 
Electric potentials 57 sented in Chapter XIII, Fig. 9, where the leak of 
current through a low impedance recording system has 
been studied and utilized for similar purposes. The experimental levelling of the surface potential 
of a lesion in relation to a reference tissue can be most 
easily explained as a closed circuit discharge of tissues 
which may be regarded as a conglomeration of biogal­
vanic cells. If this hypothesis is correct, then it should 
also be possible experimentally to charge and dis­
charge specific tissues or regions of tissue. D. Experimental charging and 
discharging of tissue 
Testing of the clinical observations on local discharge 
of a tissue was carried out in five dogs in the following 
way (see also charging of tissue in tumours of patients 
in Chapter XVU). A 1.8 mm thick catheter was introduced via a fem­
oral vessel into the lumen of the aorta or the inferior 
vena cava of the anaesthetized animal (sodium pento­
barbital).
631928626-Biologically-Closed-Electric-Ci-Bjorn-Nordenstrom-pdf.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        Other me~:hanisms for the development of lamellae 
from radiating structures are also possible. For in­
stance, altered water content or tissue atrophy may 
cause local changes in lung tissue. Local electroosmo ­
tic effects on the distribution of pulmonary water 
around a mass will later be presented as one of the 
integrated factors in the development of the radiolu­
cent "A" zone (Chapter IX). Vascular effects, con­
nected with the developmenl of local tissue atrophy 
within the "A" zone, will be treated in Section G and 
in Chapter XIV. These effects, in brief, comprise 
field-induced changes on local blood supply around a 
locally polarized tissue within a closed clt-ctric ci. rcuit. Partial displacement of Structures in the lung is also 
known to take place in local emphysema. Such dis­
placement is probably the case around the necroti7ing, 
poorly differentiated, cavitary, squamous cell carcino­
ma seen in Fig. III: 29. In the selected left posterior 
oblique projection, fiv·e coarse and broad based radiat­
ing structures can be seen perpendicular to the tumour 
surface. In this case the mass is clearly not collapsed, 
suggesting that the coarse radiating structures derive 
their shape and di. rection from emphysema tous 
changes in the pulmonary parenchyma. Coarse radiating structures can therefore develop 
around a tumour without any appreciable partial col­
lapse of a necrotic centre. When emphysema is present 
in lung around a tumour, the structures may be called 
infiltrated strands. In this way a distinction may be 
suggested regarding the development of coarse: radiat­
ing structures. The idea has been forwarded in the literature (8-H)) 
that ulinear shadows" crossing a tumour is a diagnos. tic sign of malignancy. In the author's opinion, most 
linear structures wbich seem to cross a tumour are 
merely lamellae super-impose. d over it. Obliquities of 
radiographic projection are usually essential for proper Fig.
Altered water content or tissue atrophy.
What is one possible cause of local changes in lung tissue that can lead to the development of radiating structures?
The author believes that most linear structures that appear to cross a tumour are simply superimposed lamellae, and not a diagnostic sign of malignancy.
What is the author's opinion on the relationship between "A" and "B" zones and the diagnosis of malignancy?
To diagnose between "B" zones and pleural thickening or atelectasis.
What is the purpose of injecting air into the pleural space in some cases?
The "B" zone is fluid, locally collected in the lung tissue, and the mechanical blocking of lymphatic channels between the pleura and the hilar lymph nodes.
What is the author's explanation for the disappearance of the "B" zone after air is injected into the pleural space?
The author concludes that the electric potential differences may not be sufficient to permit differential diagnosis between normal and pathologic tissues.
What is the author's conclusion about the relationship between the observed electric potentials and the diagnosis of normal and pathologic tissues?