Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Atypical Pulmonary Edema caused by Mitral Regurgitation
- Radiologic Findings
- Initial chest radiograph shows asymmetric interstitial opacities in both lungs and bilateral pleural effusion. Follow up chest radiograph taken on three days later shows improvement of the asymmetric pericardiac interstitial opacities in both lungs, but progression of right pleural effusion. chest CT shows diffuse asymmetric pulmonary edema in both lungs and bilateral pleural effusion, severe on Rt.
Transthoracic echocardiography(Fig) shows mitral valvular prolapse caused by chordae rupture (mainly P3), resulting in severe mitral regurgitation, moderate pulmonary hypertension, IVC plethora, LA enlargement and grade I diastolic dysfunction.
The patient showed elevated hs-CRP(144.44), but normal WBC count and cardiac markers such as CK-MB and troponin-I, normal invasive coronary angiogram and nonspecific EKG.
After echocardiography confirmed mitral valvular prolapse, the patient underwent mitral valvular replacement four days later.
- Brief Review
- Cardiogenic pulmonary edema secondary to left ventricular heart failure tends to be located in the dependent portions of the lungs and typically is bilateral and symmetric [1].
Atypical radiologic findings of pulmonary edema have been described in the following various conditions;(1)gravitational effect (prolonged lateral decubitus),(2)alterations in lung perfusion (pulmonary thromboembolism, chronic obstructive pulmonary disease, Swyer-James syndrome), (3) alterations in pulmonary venous drainage (unilateral veno-occlusive disease, atrial myxoma),(4) alterations in intrapleural pressure (abrupt pneumothorax reexpansion), and (5) alterations in pulmonary ventilation (bronchial obstruction) [1,2].
- References
- 1. Milne EN, Pistolesi M, Miniati M, Giuntini C. The radiologic distinction of cardiogenic and noncardiogenic edema. AJR Am J Roentgenol 1985;144:879-94.
2. Alarcon JJ, Guembe P, de Miguel E, Gordillo I, Abellas A. Localized right upper lobe edema. Chest 1995;107:274-6.
- Keywords
- Lung, Edema, Hydrostatic edema,