Pulmonary arterial hypertension is classified as idiopathic or secondary (associated with collagenoses, heart disease, portal hypertension, pulmonary thromboembolism, and pulmonary vascular diseases). Pulmonary vasoreactivity should be tested in order to define the best treatment option. Of the many drugs that have been used to test pulmonary vasoreactivity, inhaled nitric oxide is the best choice, due to its specific pulmonary effect and very short half-life (5-10 s). The results of this test identify candidates for heart surgery among patients with congenital heart disease and candidates for the use of calcium antagonists among patients with other forms of pulmonary arterial hypertension. Performing and interpreting the results of such tests are a great responsibility, since mistakes can lead to incorrect treatment decisions, resulting in the death of patients.

Keywords: Hypertension, pulmonary/diagnosis; Nitric oxide/diagnostic use; Administration, inhalation.

Introduction: Besides the improvement we have had in the diagnostic methods, the causative agent in around 50% of the cases of community-acquired pneumonia (CAP) remains unknown, even in inpatients. Despite that, adequate empirical therapy results in low mortality in the majority of the cases. Goals: To describe the epidemiology, the clinical presentation, the utility of diagnostic tests, the duration of hospital stay, the morbidity and mortality rates of 42 consecutive inpatients with CAP. Methods: The inclusion criteria were the presence of a recent pulmonar infiltrate in the CXR and two items out of fever (38ºC), productive cough and leukocytosis (> 10,000/mm3), in the presence of a compatible clinical syndrome. The subsidiary tests were performed as required on individual basis. Results: Forty-two patients, aged 64.7 ± 16.8 years, 27 (64.3%) male, were studied. Twenty-seven (64%) had subjacent illness. Seventeen (40.5%) were on antimicrobial therapy on admission. There were eight cases (19%) of severe pneumonia; the patients aged > 60 or £ 60 years were similar concerning the severity of presentation (p = 0.57) and had similar hospital stay (p = 0.25). The mean global hospital stay was 14.3 ± 7.6 days. Definite etiologic diagnosis were done in three patients: Legionella sp (2), S. aureus (1). In thirty-one cases (73.8%) the antimicrobial therapy wasn't modified; when it happened (11 patients, 26.2%), the main reason was the bad outcome in six cases (54.5%); in five (45.5%), the microbiological result prompted the change in therapy. Blood samples were drawn in 16 cases (38%), being positive in only one (6.3%). There were nine adequate sputum samples for analysis (9/22, 41%). There was only one death (2.4%), due to severe pneumonia in a patient with a neoplastic disease. Conclusion: The etiologic diagnosis in CAP is reached in a minority of cases, even in inpatients. At least partly, this is probably due to the previous use of antimicrobial drugs. Adequate empirical therapy results in low mortality. Diagnostic tests can be performed on individual basis.

Keywords: Pneumonia. Community acquired infections. Epidemiology. Therapeutics.

Intimal sarcoma of the pulmonary artery is a rare and potentially lethal tumor, the diagnosis of which is difficult and therefore frequently delayed. The clinical signs and symptoms are nonspecific, often mimicking chronic pulmonary thromboembolism (CPTE). We report the case of a 45-year-old male under treatment for CPTE associated with pulmonary arterial hypertension and chronic cor pulmonale. There was no response to treatment with anticoagulants and sildenafil. We emphasize the difficulties in diagnosing intimal sarcoma of the pulmonary artery, the need to investigate this neoplasm in the differential diagnosis of CPTE and the systematic use of criteria for the appropriate prescription of new medications for pulmonary artery hypertension.

Keywords: Pulmonary embolism; Hypertension, pulmonary; Hemangiosarcoma; Diagnosis, differential.