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대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 87 Date 1999-06-26

  • Courtesy of Jin Mo Goo, MD, Jung-Gi Im, MD, / Seoul National University Hospital, Seoul, Korea
  • Age/Sex 59 / F
  • Chief Complaintchest pain, dyspnea
  • Figure 1
  • Figure 2

Fig. 1 (29 May)

Diagnosis With Brief Discussion

Diagnosis
Localized Pulmonary Edema
Radiologic Findings
The patient suffered from acute myocardial infarction 5 days ago. The supine chest radiograph (Fig. 1) shows bilateral parahilar haziness suggesting pulmonary edema. Swan-Ganz catheter is also seen. Two days later air-space consolidation developed in right upper lobe (Fig. 2). Echocardiography revealed mitral regurgitation and papillary muscle dysfunction. The consolidation in right upper lobe disappeared after therapy with diuretics and inotropic agents (Fig. 3).
Brief Review
Focal patterns of pulmonary edema are confusing and often mistaken for the more common causes of focal lung disease, pneumonia, infarction, or aspiration. Pulmonary edema localized to the right upper lobe occasionally has been observed in patients with mitral incompetence. It is believed that back flow across the incompetent mitral valve is directed at the orifice of the right upper lobe pulmonary vein This raises pulmonary venous pressures and increases pulmonary edema in that lobe (1). Pulmonary edema accompanying mitral regurgitation should be suspected whenever right upper lobe consolidation develops in a patient with known or suspected mitral valve disease. The presence of interstitial edema in the remainder of the lungs can help in the differentiation of this condition from pneumonia and other disorders. Acute mitral incompetence secondary to papillary muscle dysfunction or rupture can result in florid changes of acute pulmonary edema (2).
References
1. Gurney JW, Goodman LR. Pulmonary edema localized in the right upper lobe accompanying mitral regurgitation. Radiology 1989;171:397-399.
2. Morgan PW, Goodman LR. Pulmonary edema and adult respiratory distress syndrome. Radiol Clin North Am 199;29:943-963.
Keywords
Lung, Edema, Hydrostatic edema,

No. of Applicants : 11

▶ Correct Answer : 3/11,  27.3%
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