A case of polypoid sarcoma of the pulmonary trunk is described in an 80-year-old woman who had a 21-year history of episodic chest pain and hemoptysis. Ultrastructural examination revealed Z bands, characteristic of rhabdomyosarcoma, and leptomeric organelles. This is the 60th reported case of sarcoma of the pulmonary trunk. Symptoms in reported cases were variable, usually caused by tumor emboli to the lungs or by right ventricular outflow obstruction. Angiography was diagnostic. The tumor was characteristically polypoid, often multicentric, and by definition was fixed to the pulmonary trunk or valves. Non-differentiated sarcoma (often uniquely pleomorphic) was found in 37% of patients, leiomyosarcoma (once confirmed by electron microscopy) in 17%, myxosarcoma in 13%, elements of rhabdomyosarcoma in 8%, fibrosarcoma in 8%, elements of chondrosarcoma in 11%, and 5% were malignant mesenchymomas. The authors suggest that these tumors originate from the undifferentiated tissues of the bulbus cordis and propose the name myenchymoma for the tumor.
Elevated venous pressure in right heart failure leads not only to an increase in lymph formation but also to progressive resistance in the neck to the return of lymph to the circulation via the thoracic duct. Sequestration of fluid behind the failing heart tends to protect the circulation but at the same time leads to the clinical manifestations of heart failure.
The present study was performed on 40 dogs with combined tricuspid insufficiency and pulmonary stenosis. Thoracic duct lymph flow was greatly increased. Pressure was considerably greater in the systemic veins than in the pulmonary vein beyond the right heart obstruction. Lymph flow was substantially enhanced when the thoracic duct was connected to the lower pressure pulmonary veins. Furthermore, direct anastomosis of the thoracic duct to the pulmonary vein resulted in fall in systemic venous pressure, increase in renal excretion of salt and water, and reduction in ascites. These results indicate that alterations in the flow of thoracic duct lymph have important bearing on the manifestations and treatment of right heart failure.
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