patient it seemed to resolve post-op Day 2, responding only to surgery having been refractory medically prior to that.In summary, cardiogenic pulmonary oedema remains a possible and sufficient explanation for asymmetric right upper lobe pulmonary abnormalities in a patient with significant mitral valve regurgitation. Transthoracic and/or transoesophageal echocardiography with particular attention to mitral regurgitation jet direction and demonstration of regurgitant systolic reversal of flow into right pulmonary vein(s) would corroborate this diagnosis. Clinical judgment may mandate the need to exclude other coexisting pulmonary pathology, but indeed the sole underlying pathology may be cardiac. Such pulmonary oedema may persist despite aggressive medical measures and resolve only after surgical correction of the valve dysfunction.