Pulmonary hypertension and cor pulmonale.

This article is directed primarily to primary care physicians. The challenge is to suspect, diagnose, and treat pulmonary arterial hypertension when treatment is most effective and before the effects of cor pulmonale become fully manifested. A good history and physical examination should be followed by electrocardiographic and roentgenographic evaluations.

Mycobacterium fortuitum pulmonary infection complicating achalasia.

Achalasia is a cause of chronic aspiration pneumonia that may be complicated by pulmonary infection with Mycobacterium fortuitum. In any patient with achalasia, the presence of a pulmonary infiltrate that does not respond to routine antibiotic therapy should suggest the possibility of M fortuitum pulmonary infection, and sputum should be cultured for these organisms.

Pulmonary disease caused by nontuberculous mycobacteria.

Nontuberculous mycobacterial pulmonary infections have become more common in recent years. The diagnosis is often overlooked because the findings may be subtle or because the radiographic appearance may change slowly or not at all for long periods of time. As a rule, the radiographic findings of nontuberculous mycobacterial pulmonary infections are identical to those of tuberculosis in any given patient.

Air-filled, multilocular, bronchopulmonary foregut duplication cyst of the mediastinum. Unusual computed tomography appearance.

Mediastinal bronchopulmonary foregut duplication cysts are usually identified on computed tomography (CT) as well-defined masses of water density that may contain rim calcification. Occasionally they are heterogenous in attenuation or are of intermediate or high attenuation due to contained calcium. Communication with the tracheobronchial tree or esophagus is rare.

Intrathoracic lymphadenopathy in postprimary tuberculosis.

In the past, hilar or mediastinal lymphadenopathy was considered by many to be a feature of only the primary or first infection with Mycobacterium tuberculosis, and to exclude the diagnosis of reactivation or postprimary tuberculosis. In a series of 56 adult patients with documented postprimary disease due to M tuberculosis, we found hilar or mediastinal lymphadenopathy in three cases (5%). Although intrathoracic lymphadenopathy was more common in primary tuberculosis, we do not believe that intrathoracic lymphadenopathy is as specific for primary tuberculosis, particularly in the adult, as was once thought.