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We describe a patient with biopsy-proven pulmonary talc granulomas (secondary to the long-term intravenous injection of crushed tablets of pentazocine) who had two episodes of transient pulmonary hypertension following the injection of this oral medication. We established a canine model and measured the right lymph duct flow, mean pulmonary arterial pressures, and pulmonary vascular resistance to determine the short-term effects on hemodynamics and the flow of lymph after intravenous administration of crushed pentazocine tablets (3 to 4 mg/kg of body weight) or pure talc (2.5 to 3 mg/kg). A typical response to both agents consisted of short-term elevations of mean pulmonary arterial pressure and pulmonary vascular resistance to approximately twice baseline values, with a slow decrement over 30 to 45 minutes. The average flow of lymph tripled, peaking at approximately two hours after injection. The lymph contained high levels of albumin. We concluded that the talc filler in oral tablets of pentazocine induces the pulmonary hypertension, probably by mechanical obstruction of the pulmonary vasculature. Association with this transient pulmonary hypertension is an increase in the permeability of the pulmonary microvasculature.

Ethchlorvynol (10 mg/kg) causes transient pulmonary hypertension and an increased permeability pulmonary edema in sheep. To determine the role of cyclooxygenase and its metabolites, histamine, and catecholamines in both phenomena, we studied five groups of sheep: group I, placebo; group II, ethchlorvynol; group III, indomethacin with ethchlorvynol; group IV, diphenhydramine with ethchlorvynol; group V, phentolamine with ethchlorvynol. Indomethacin, but not diphenhydramine or phentolamine, blunted the pulmonary hypertensive response seen immediately following the ethchlorvynol injection. However, none of the drugs had any effect on the increased permeability pulmonary edema. We conclude that cyclooxygenase or its metabolites partially mediates the hypertensive response but not the increased permeability pulmonary edema seen in sheep following ethchlorvynol injection.