The clinical recognition of pulmonary hypertension in the absence of overt right heart failure may be difficult. Prior to the development of echocardio-graphic techniques right heart catheterization was the only method of establishing the diagnosis. However, echocardiography, particularly with the Doppler study, has been shown to be a sensitive, noninvasive technique for determining the presence of pulmonary hypertension. The results of the present study in which seven of 11 patients with polymyositis had echocardiographic evidence of pulmonary hypertension suggests that pulmonary vascular involvement is common in this disorder. Ventilation and perfusion scans were obtained in the first three patients with pulmonary hypertension to exclude possible pulmonary embolism. All three patients had normal or low probability scans so that further scanning was not thought to be clinically indicated. buy ortho tri-cyclen online
In contrast to the subtle manifestations of pulmonary hypertension, parenchymal lung involvement in polymyositis usually is readily apparent. The majority of such patients complain of dyspnea. While restrictive dysfunction due to respiratory muscle weakness can develop in the presence of a normal chest radiograph, most patients with parenchymal involvement have radiographic evidence of diffuse interstitial disease. Histologic examination of biopsy or autopsy specimens, or both, reveals nonspecific interstitial pulmonary fibrosis.