THE.HE DEVELOPMENT of pulmonary hypertension and cor pulmonale is common in chronic pulmonary disease. In chronic obstructive lung disease, the major pathogenetic factor appears to result from pulmonary vasoconstriction produced by hypoxemia or acidosis occurring with alveolar hypoventilation.1,2 In the restrictive lung diseases reduction of the pulmonary vascular bed appears to be the major factor.
The occurrence of pulmonary hypertension in chronic constrictive pleuritis has not, to our knowledge, been previously emphasized. The few cases reported in the literature have implied that pulmonary hypertension in constrictive pleuritis occurs only with more or less generalized pleural involvement and is related to the same mechanism which operates in chronic obstructive lung disease, that is, depends on alveolar hypoventilation with resultant hypoxemia and acidosis.3
This paper will report four patients in whom severe pulmonary hypertension was associated with chronic constrictive pleuritis. It will be shown that even relatively localized (unilateral) pleural