대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

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,