Reversible pulmonary hypertension and cardiac failure with chronic recurrent pancreatitis.

REVERSIBLE PULMONARY HYPERTENSION 689 Ficuax 1. Preoperative posteroanterior chest x-ray film. Note calcified margins of mass. peel was removed, the underlying lung was seen to expand, except for the right upper lobe, which contained the old tuberculosis. After surgery the patient did require a naso-tracheal tube and respiratory support for several days, eventually undergoing tracheostomy. After 14 days of respiratory support the patient was weaned from the respirator. Her strength, pulmonary reserve, and chest x-ray film slowly improved over the ensuing nine months (Fig 2). DIscussIoN Collapse therapy for tuberculosis was one of the oldest effective methods of treating the disease. Collapse therapy took several forms, including plombage. Eloesser' described extrapleural plombage, with a high complication rate of fistula and empyema. Alexander2 Fictmx 2. Posteroanterior chest x-ray film taken nine months after surgery. used semisolid paraa n in the extrapleural position. This resulted in a very thin fibrous envelope with almost no reaction of the surrounding tissue. In spite of the use of plombage as a salvage maneuver,' the rate of closure of cavities was reported to be as high as 85 percent. In this patient, roentgenographic findings in the early postoperative period revealed hazy infiltrates in the newly expanded lung, which were believed to represent either interstitial fluid or hemorrhage related to the sudden expansion of the pulmonary tissue after 35 years of compression. This radiographic picture gradually cleared as the pulmonary function improved in the early postoperative period. In spite of the development of what was apparently a small broncho-pleural fistula (which healed spontaneously), the pa-tient's postoperative convalescence was relatively smooth, and at the time of this writing, she is asympto-matic and has resumed full activities. This experience suggests that with the probability of finding normal pulmonary tissue with extrinsic compression, even 35 years of compression is no contraindication to decortication in an attempt to improve respiratory function.