Thrombosis of the Pulmonary Arteries

Abstract

Circulatory failure of an extracardiac nature caused by pulmonary emphysema, kyphoscoliosis, sclerosis of the pulmonary arterioles, and Ayerza’s disease is not too uncommon to warrant intensive clinical investigation. The classical syndrome of dyspnea, cyanosis, pain in the chest with or without cardiac signs, and a normal blood count may tax the acumen of the clinician to differentiate between pulmonary or heart disease. A patient who recently entered the Cleveland Clinic presented this syndrome.

Case Report

A forty-seven year old white woman entered the Clinic on April 29, 1940, with the complaint of cough, pain in the chest, loss of weight, nervousness, fever, and shortness of breath. The patient dated the onset of her illness to a difficult labor four years previously. Her only symptom was dyspnea on moderate exertion until September, 1939, when she began to have nervousness, palpitation, and increasing dyspnea on lessened exertion. Two months later, the patient noticed “knots” on the abdomen which were not sensitive to touch, and swelling of the veins on the posterior aspect of the thighs and over each buttock. Associated symptoms were loss of weight and swelling of the ankles. The basal metabolic rate taken at that time was plus 40 per cent. Roentgen examination of the chest was normal. Her symptoms were not alleviated by the use of digitalis, Lugol’s solution, and bed rest, but they improved spontaneously, and she was quite active for four months.

Four weeks before examination at the Clinic, the patient began to cough, producing about one. . .