Unilateral pulmonary edema: a case report and review of the literature

Abstract

BackgroundUnilateral pulmonary edema is an uncommon condition and is a rare clinical entity that is often misdiagnosed at the initial stages. In a majority of patients it occurs in the upper lobe of the right lung. There are many causes of unilateral pulmonary edema, but the commonest is the presence of a grade 3 mitral regurgitation. Due to its rare presentation, a high index of suspicion is required, and correct management is necessary to reduce the morbidity and mortality.Case presentationWe present a case of right-sided unilateral pulmonary edema in an 86-year-old Sinhalese Sri Lankan woman who presented with acute onset dyspnea with cardiogenic shock due to acute non-ST elevation myocardial infarction, complicated with grade 3 mitral regurgitation. She had clinical features of heart failure and pulmonary edema, but a chest X-ray showed unilateral infiltrates only on the right side. Distinguishing pneumonia from pulmonary edema according to chest X-ray findings was a challenge initially, and she was therefore initially treated for both conditions. She had remarkable clinical and radiological improvement after 12 hours of intravenously administered furosemide and glyceryl trinitrate therapy. Her brain natriuretic peptide level was elevated and further supported and confirmed the diagnosis retrospectively.ConclusionsUnilateral pulmonary edema is a completely reversible condition with good patient outcome if it is suspected early and treated early. Even in the absence of readily available echocardiogram skills, a clinical examination is of paramount importance in making a clinical decision in low-resource settings to reduce mortality.

Unilateral Diffuse Alveolar Hemorrhage Due to Selective Directionality of Mitral Regurgitant Jet in a Patient With Severe Aortic Stenosis

“…Patients with DAH due to a cardiac etiology are treated with supportive therapy and optimization of cardiac filling pressures. This is usually achieved by judicial use of diuretics, vasopressors, and sometimes, with appropriate mechanical interventions [17].…”

Unilateral cardiogenic pulmonary edema caused by acute mitral valve prolapse

“…[ 4 ] Another explanation is that regurgitation causes a sudden increase in left atrial pressure, after which the lymphatic drainage capacity of the right lung becomes worse than that of the left, which can lead to edema and induce right UPE. [ 5 ]…”

Post-surgical unilateral left pulmonary edema after mitral valve replacement – A diagnostic challenge

“…[ 1 2 ] The causes of UPE can be categorized as primarily cardiogenic, which includes more commonly pulmonary vein thrombus, occlusion, unilateral hypoplastic pulmonary artery, congenital or surgical right-to-left shunt (e.g., Blalock–Taussig shunt), intraoperative or postoperative left lateral positioning for prolonged periods, congestive heart failure, ventricular septal rupture post acute myocardial infarction, fluid overload or primarily pulmogenic, which includes unilateral pulmonary embolism, emphysema/bullae, reexpansion pulmonary edema after thoracocentesis for massive pneumothorax or pleural effusion, Swyer-James syndrome, and pneumonia, among others. [ 3 4 5 ] It is also seen in the normal lung in patients with unilateral pulmonary disease, such as MacLeod syndrome and unilateral pulmonary artery hypoplasia or agenesis, pulmonary artery compression from aortic dissection or left ventricular pseudo-aneurysm, and pulmonary venous obstruction from mediastinal fibrosis. [ 6 ]…”