Left-Sided Unilateral Pulmonary Edema in Postinfarction Ventricular Septal Rupture

Akiyama, K; Suetsugu, Fuminaga; Hidai, Tiaki; Shimamoto, Ken; Takahashi, Sanae

doi:10.1378/chest.105.4.1264

Cited by 16 publications

(11 citation statements)

References 5 publications

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“…These focal increased pressures may thus promote the unilateral presentation. In our series, UPE was right-sided in 89% of cases, and left-sided UPE was infrequent 4 and represented only 0.2% of all cardiogenic pulmonary edema. These different chest x-ray patterns may be explained by many factors, including direction and severity of MR but also anatomic position of pulmonary veins in the left atrium and anatomic drainage of pulmonary veins.…”

Section: Discussionmentioning

confidence: 55%

“…16 In our population of patients with cardiogenic pulmonary edema, we found an estimated UPE prevalence of 2.1%, showing that UPE is not as unusual as presumed. Vascular or bronchial obstruction, congenital heart disease, and prolonged rest on one side may induce UPE, 4,5,17,18 but severe MR remains the main cause of UPE. 9,10 In our study, UPE was always associated with severe MR and represented 25% of pulmonary edema with severe MR. Two previous studies found that 9% and 22% of patients presenting with severe MR and signs of congestive heart failure had radiological signs of UPE, mainly in the right upper lobe.…”

Section: Discussionmentioning

confidence: 99%

“…The unilateral location of cardiogenic pulmonary edema is unusual [3][4][5][6][7][8] and has rarely been described and mainly reported in association with severe mitral regurgitation (MR). 9,10 Little is known about the characteristics of unilateral pulmonary edema (UPE), and its prevalence has never been assessed in a large series of pulmonary edema.…”

Section: Clinical Perspective On P 1115mentioning

confidence: 99%

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Prevalence, Characteristics, and Outcomes of Patients Presenting With Cardiogenic Unilateral Pulmonary Edema

et al. 2010

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Background-Cardiogenic unilateral pulmonary edema (UPE) is a rare entity, frequently leading to initial misdiagnosis.We sought to assess the prevalence of UPE and to determine its impact on prognosis compared with bilateral pulmonary edema. Methods and Results-We studied the characteristics and outcomes of patients admitted to our institution for cardiogenic pulmonary edema during an 8-year period. The study population included 869 consecutive patients. The prevalence of UPE was 2.1%: 16 right-sided UPE (89%) and 2 left-sided UPE (11%). In patients with UPE, blood pressure was significantly lower (PՅ0.01), whereas noninvasive or invasive ventilation and catecholamines were used more frequently (Pϭ0.0004 and PϽ0.0001, respectively). The prevalence of severe mitral regurgitation in patients with bilateral pulmonary edema and UPE was 6% and 100%, respectively (PϽ0.0001). In patients with UPE, use of antibiotic therapy and delay in treatment were significantly higher (PϽ0.0001 and Pϭ0.003, respectively). In-hospital mortality was 9%: 39% for UPE versus 8% for bilateral pulmonary edema (odds ratio, 6.9; 95% confidence interval, 2.6 to 18; PϽ0.001). In multivariate analysis, unilateral location of pulmonary edema was independently related to death whatever the model used (adjusted odds ratio, 6.5; 95% confidence interval, 1.3 to 32; Pϭ0.021 for model A; and adjusted odds ratio, 6.8; 95% confidence interval, 1.1 to 41; Pϭ0.037 for model B). Conclusions-Unilateral pulmonary edema represented 2.1% of cardiogenic pulmonary edema in our study, usually appeared as an opacity involving the right lung, and was always associated with severe mitral regurgitation. Unilateral pulmonary edema is related to an independent increased risk of mortality and should be promptly recognized to avoid delays in treatment. (Circulation. 2010;122:1109-1115.)

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective On P 1115mentioning

confidence: 99%

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Prevalence, Characteristics, and Outcomes of Patients Presenting With Cardiogenic Unilateral Pulmonary Edema

et al. 2010

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“…In addition, left-sided cardiac enlargement resulting from heart failure has the potential to physically impede the blood flow in the left pulmonary artery, thus inducing right-sided pulmonary congestion in such patients (18). Another mechanism is poor lymphatic drainage in the right lung due to the presence of a small-caliber right bronchomediastinal trunk in comparison with that of the left lung with a large-caliber thoracic duct (19). Moreover, various right pulmonary venous drainage patterns are associated with right-sided pul-monary congestion (20).…”

Section: Discussionmentioning

confidence: 99%

Diffuse Alveolar Hemorrhage with Predominantly Right-sided Infiltration Resulting from Cardiac Comorbidities

et al. 2015

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Objective Radiographic findings in patients with diffuse alveolar hemorrhage (DAH) are usually diffuse and bilateral, although they may occasionally be unilateral. The clinical aspects of predominantly unilateral DAH are not well known. Therefore, our objective was to describe the clinical characteristics of predominantly right-sided DAH. Methods We retrospectively reviewed data for 460 bronchoalveolar lavage fluid (BALF) samples collected between January 2009 and July 2013. Patients who presented with increasingly hemorrhagic BALF were diagnosed with DAH, and unilateral predominance was determined based on the degree of infiltration on chest radiographs. Results The records of 54 patients with DAH were evaluated. The leading etiology was pulmonary congestion due to heart failure (n=15). The radiographs showed right-sided infiltration in 18 patients (33%), leftsided infiltration in six patients (11%) and bilateral infiltration in 30 patients (56%). Predominantly rightsided DAH was often caused by pulmonary congestion resulting from heart failure (10 of 18 patients). A multivariate logistic regression analysis revealed a previous history of cardiovascular disease to be the only significant predictor of right-sided DAH (OR 13.1, 95% CI 2.9-95.4). Conclusion Predominantly right-sided DAH is frequently caused by pulmonary congestion resulting from heart failure and is significantly related to comorbidities with cardiovascular disease.

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“…A possible explanation is the poorer lymphatic drainage of the right lung by the small-caliber right bronchomediastinal trunk in comparison with that of the left lung by the large-caliber thoracic duct (5). Another explanation relates to the left-sided cardiac enlargement that develops in most patients with heart failure and that may physically impede blood flow in the left pulmonary artery, thereby reducing capillary volume (6).…”

Section: Discussionmentioning

confidence: 99%

Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction

et al. 2012

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Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.

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Left-Sided Unilateral Pulmonary Edema in Postinfarction Ventricular Septal Rupture

Cited by 16 publications

References 5 publications

Prevalence, Characteristics, and Outcomes of Patients Presenting With Cardiogenic Unilateral Pulmonary Edema

Prevalence, Characteristics, and Outcomes of Patients Presenting With Cardiogenic Unilateral Pulmonary Edema

Diffuse Alveolar Hemorrhage with Predominantly Right-sided Infiltration Resulting from Cardiac Comorbidities

Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction

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