CARCINOMATOUS ENDARTERITIS OF THE PULMONARY VESSELS RESULTING IN FAILURE OF THE RIGHT VENTRICLE

Abstract

Hypertension of the pulmonary circulation with hypertrophy and consequent failure of the right ventricle is most frequently due to mitral stenosis or to chronic bronchitis and emphysema of long duration. The rôle of these mechanical causes of hypertension of the lesser circulation has been recently reemphasized by Moschcowitz.¹ In a group of cases described by Eppinger and Wagner² and by others (MacCallum³) as primary sclerosis of the pulmonary vessels, the etiology of the vascular lesion is largely unknown. There is, however, a rather uncommon group in which diffuse metastatic carcinomatous lymphangitis is associated with widespread obliterative endarteritis of the pulmonary vessels. The widespread obliterative endarteritis causes a generalized narrowing of the pulmonary circulation followed by right ventricular hypertrophy and finally right ventricular cardiac failure. In 1874, Troisier⁴ described an interesting clinical picture in patients with carcinomatous lymphangitis of the lungs secondary to carcinoma of the stomach.