Unilateral cardiogenic pulmonary edema associated with acute mitral regurgitation

Abstract

CaseTwo cases of cardiogenic unilateral pulmonary edema are reported. Both patients presented to the emergency department with dyspnea, and chest radiography revealed unilateral infiltration, which mimics pulmonary disease. However, the patients were diagnosed with cardiogenic pulmonary edema, because echocardiography showed severe mitral regurgitation with an eccentric jet.OutcomeThe patients underwent mitral valve replacement and were discharged without complications.ConclusionUnilateral cardiogenic pulmonary edema is rare, and early diagnosis and treatment are difficult. Delayed treatment leads to high mortality. The major cause of unilateral pulmonary edema is acute mitral regurgitation, and the direction of the jet is suggested as a mechanism of laterality.

Acute Mitral Valve Regurgitation Presenting With Right Upper Lobe Opacification

“…The first case involved an eccentric jet blowing towards the right side of the left atrium and a patient who presented with right-sided opacities. The second case involved a jet blowing towards the left side of the left atrium and a patient who presented with left-sided opacities [ 2 ]. In this case, a regurgitant jet was directed towards the right upper pulmonary vein, causing right upper lung opacification, substantiated by TEE pulse wave doppler images confirming severe systolic flow reversal within the right upper pulmonary vein.…”

“…Unilateral infiltrates on chest radiography, often seen in bacterial pneumonia, may evoke an infectious etiology of dyspnea. However, focal or unilateral pulmonary edema has been described in patients with mitral regurgitation from numerous causes, including spontaneous valve perforation [1], valve perforation due to infectious endocarditis [2], transient papillary muscle dysfunction due to myocardial ischemia [3], and spontaneous papillary muscle or chordae tendineae rupture [4][5][6]. Case reports show that this finding is often initially mistaken for pneumonia or other respiratory illnesses [7].…”

Unilateral cardiogenic pulmonary edema caused by acute mitral valve prolapse

“…On day 3, we consulted with a senior ultrasonography radiologist who found a posterior mitral valve leaflet prolapse and possible rupture of the chordae tendineae of the posterior mitral valve. If bedside ultrasound B-scan cannot confirm a diagnosis of MR, there have been reports [ 6 , 7 ] that the use of transesophageal echocardiography can be used to assess the degree of MR more accurately and reduce misdiagnosis.…”

Edema pulmonar unilateral de las grandes alturas. Reporte de caso

“…En los diferentes reportes de caso, el edema agudo de grandes alturas suele ocurrir entre 1-4 días después de la llegada a altitudes superiores a 2500 m s. n. m. (12). En nuestro caso, se reportó a un paciente sano con sintomatología súbita, la cual se desarrolló en el lapso de 24 horas, y en quien se documentó un defecto congénito del septo interauricular desconocido por el paciente que no se había manifestado en ascensos previos.…”

“…Este cuadro se asocia con la aparición de estertores y cianosis al examen físico como consecuencia del intercambio gaseoso alveolar alterado (5), lo cual desemboca en una hipoxemia profunda, progresión hacia la insuficiencia respiratoria aguda con requerimientos de ventilación mecánica y manejo en una unidad de cuidados intensivos (UCI) y, en casos graves, la muerte si no se interviene oportunamente. Aunque desde el punto de vista fisiopatológico es más frecuente la aparición del edema pulmonar de forma bilateral (6), existe un porcentaje bajo de pacientes que presentan edema unilateral relacionado con patologías pulmonares o cardíacas preexistentes (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”