Large tonsils and adenoids in small children with cor pulmonale.

Although small children with large inflamed nasopharyngeal lymphoid masses have been part of human ecology since the move east of Eden, the syndrome of cor pulmonale consequent to upper airway obstruction was not described until 1965 (Menashe, Farrehi, and Miller, 1965; Cox et al., 1965). These and subsequent reports (Noonan, 1965; Luke et al., 1966) defined the clinical syndrome of noisy, stertorous respirations, somnolence, clinical and electrocardiographic evidence of right ventricular hypertrophy, radiological findings of cardiomegaly, and occasionally pulmonary oedema and right heart failure. Like all clinical syndromes, there are numerous variations about the central unifying theme. Through recounting our experience with six of these patients, observed within a two-year period, we wish to illustrate some of these variations. Particular emphasis will be directed toward lability of the clinical, electrocardiographic, and radiological findings; and the ever present danger of death from either respiratory or cardiac arrest.