Right upper lobe pulmonary edema as consequence of mitral regurgitation

Agésilas, F.; Herbland, Alexandre; Valentino, Ruddy; Rieux, D; Lebrun, Jocelyne; Crombé, Christian; Mehdaoui, Hossein; Schlossmacher, P.; Gey, Florence

doi:10.1016/j.ajem.2006.04.009

Cited by 2 publications

(2 citation statements)

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“…21 The main mechanism of MR in UPE is mitral leaflet prolapse, but functional MR may also be involved, as demonstrated in our study and in previous case reports. 6,22 The unilateral x-ray pattern may lead to false diagnosis of pneumonia and delayed management. In 18 pregnant women presenting with pulmonary edema, Choi et al 23 have shown that patients with UPE had initial misdiagnosis (pneumonia), resulting in delays in treatment and resolution (4 to 5 days).…”

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: 99%