CHRONIC NASOPHARYNGEAL OBSTRUCTION AS A CAUSE OF CARDIOMEGALY, COR PULMONALE, AND PULMONARY EDEMA

Abstract

Partial airway obstruction and respiratory abnormality due to enlargement of tonsils and adenoids is a well-recognized clinical entity, but the cardiorespiratory changes which severe chronic obstruction may cause have not been widely documented. Four patients with severe nasopharyngeal obstruction have been observed to have cardiorespiratory complications ranging from moderate cardiac enlargement and right ventricular hypertrophy to cor pulmonale and pulmonary edema. Hemodynamic studies showed swings in pulmonary artery and aortic pressures; pCO₂ was varyingly elevated in arterialized capillary blood. It is believed that hypoxia leads to increased pulmonary resistance and elevated pulmonary artery pressure which, over a period of months, results in right heart hypertrophy and failure. Furthermore, hypoxia may contribute to the development of pulmonary edema in a manner similar to that which occurs at high altitudes. Wide swings in intrathoracic pressure also probably played an important role in the etiology of pulmonary edema. Individual susceptibility to hypoxia and pressure changes is suspected to be an important etiologic factor. The problem of chronic upper airway obstruction caused by tremendously enlarged tonsils and adenoids in children warrants further investigation and more widespread recognition as being potentially dangerous from cardiorespiratory standpoints.