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Image of the Month—Diagnosis
Arch Surg. 2004;139:1018.
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Answer: Small Left Apical Pneumothorax, Left Tube Thoracostomy, and a Prominent Right Central Pulmonary Artery
Figure. Chest radiograph showing a 1-cm left apical pneumothorax, left tube thoracostomy with a Foley catheter, and a prominent central right pulmonary artery suggestive of pulmonary hypertension.
Figure appears in full text version.
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Pulmonary hypertension may be either primary (idiopathic) or secondary. The pathogenesis of primary pulmonary hypertension may be (1) neurohormonal vascular hyperreactivity as a central mechanism in which chronic vasoconstriction induces pulmonary hypertension with ensuing intimal and medial vascular hypertrophy, (2) immune collagen vascular diseases, or (3) atherosclerosis.
Secondary pulmonary hypertension may be associated with (1) chronic obstructive or interstitial lung disease, (2) recurrent pulmonary emboli, or (3) antecedent heart disease. As the disease progresses, the right ventricle compensates through hypertrophy. Although the right ventricle can sustain elevated pressures for months to years, decompensation eventually occurs. The diagnostic workup includes electrocardiography, echocardiography, and cardiac catheterization.
Medical management is poorly understood and very complex. Treatment includes a combination of oxygen, diuretics, digoxin (Lanoxin; . . . [Full Text of this Article]
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