Archived case 191 · November 23-November 30, 2015
What is the dominant abnormality on the admission radiograph? Is the pattern typical or atypical for this process? If atypical, what might be the cause?
Is the pattern the same on the post-operative film? What procedure has he had done?
Images: On the initial radiograph, vascular clarity is diminished and there is generalized interstitial prominence which appears to particularly involve the right upper lobe. The heart is enlarged and there are small bilateral pleural effusions. On the follow up radiograph, the edema pattern has improved. MRI SSFP cine images demonstrate a flow jet across the mitral valve consistent with insufficiency. Answer Diagnosis: Asymmetric right upper lobe pulmonary edema related to severe mitral valve insufficiency.
Asymmetric right upper lobe pulmonary edema related to severe mitral valve insufficiency
Unilateral/asymmetric pulmonary edema cases represents approximately 2 % of cardiogenic pulmonary edema. It typically involves the right upper lobe and is strongly associated with severe mitral regurgitation. This may be because the regurgitation jet is directed towards the right superior pulmonary vein which would preferentially increase the hydrostatic pressure in the right upper lobe. Other causes include re-expansion edema, pulmonary vein occlusion, and positioning related. When associated with mitral regurgitation, it is usually a result of a flail posterior leaflet, which can be caused by rupture of the chordae tendineae or papillary muscle.
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Original case written by its authors at Virginia Commonwealth University and published at this address as part of a weekly teaching collection. Reproduced here as an archive.