Differentiation of Recurrent Pulmonary Emboli from Chronic Obstructive Lung Disease as a Cause of Cor Pulmonale

Our plain-English summary of Differentiation of Recurrent Pulmonary Emboli from Chronic Obstructive Lung Disease as a Cause of Cor Pulmonale, by C.H. Fanta, T.C. Wright, E.R. McFadden (1981).

The study

• Authors: C.H. Fanta, T.C. Wright, E.R. McFadden
• Published: Chest 79(1):92-95 January (1981)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This clinical report described one patient treated at the Peter Bent Brigham Hospital in Boston. The patient had chronic obstructive lung disease, severe breathlessness and cor pulmonale, a form of right-sided heart failure caused by lung disease. Breathing tests showed moderately severe airway obstruction. A perfusion lung scan was read as showing a low probability of a blood clot in the lungs. Pulmonary angiography showed enlarged central lung arteries and pruned peripheral branches but no definite evidence of clots. Heart catheterization documented high pressure in the lung arteries. A clot was found in a calf vein. The patient received intravenous heparin and had both femoral veins tied off. The patient improved gradually but died after a cardiopulmonary arrest on the 36th hospital day. Autopsy found chronic bronchitis and emphysema, and numerous clots of various ages in the small lung arteries and arterioles. The large lung arteries were free of clots. The authors concluded that the case showed how hard it can be to diagnose small, repeated clots in someone who also has chronic obstructive lung disease. This article does not concern asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One patient with chronic obstructive lung disease, severe breathlessness and cor pulmonale, treated at the Peter Bent Brigham Hospital, Boston (the patient's age is unreadable in the scanned text)
• Main results:
  • Pulmonary function tests in the patient showed a forced vital capacity of 3.70 L (76 percent of predicted); the one-second forced expiratory volume was 49 percent of expected
  • The one-second forced expiratory volume in the patient was 49 percent of expected
  • A perfusion lung scan in the patient was interpreted as indicating a low probability of pulmonary embolus
  • Cardiac catheterization documented pulmonary artery hypertension with normal left ventricular filling pressures
  • Pulmonary vascular resistance was calculated as nearly two thirds of the systemic value
  • Selective pulmonary angiography showed enlargement of the central pulmonary arteries with pruning of peripheral branches, without definitive evidence of discrete emboli
  • Venography identified a definite clot in a calf vein
  • The patient was treated with continuous intravenous heparin
  • Bilateral femoral vein ligations were performed
  • The patient improved gradually, then had a cardiopulmonary arrest on the 36th hospital day and could not be resuscitated
  • Autopsy confirmed chronic bronchitis and emphysema
  • Autopsy found numerous thromboemboli of various ages in the small arteries and arterioles, and the large pulmonary arteries were free of emboli
  • Autopsy also showed evidence of paradoxical embolization of the kidneys
  • The patient breathed rapidly, at more than 30 breaths per minute, which the authors described as unusual in airway obstruction severe enough to cause cor pulmonale
• The authors' conclusion: The authors concluded that the case illustrated the extreme difficulty of diagnosing small pulmonary emboli when they are superimposed on chronic obstructive lung disease. In their view, rapid breathing, lung function impairment too mild to explain cor pulmonale, and persistent low carbon dioxide together with severe low oxygen pointed to emboli rather than airway obstruction as the main cause.

Topics

Medical terms in this study, explained in our Lexicon: Obstructive Lung Disease, Cor Pulmonale, Autopsy, Emphysema.

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