Case of the Week: 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?

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Case Details

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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.

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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Correct answers by users

Radiology Medicine/Pulmonary
VCU Resident
Others
  • Mohammed AlthobaitiSaudi Arabia
  • Krishna Prasad Bellam PremnathUnited Kingdom
  • Carlo FlorioItaly
  • Abdul JabbarPakistan
  • JAYANTH KESHAVAMURTHYUnited States of America
  • Amarah Kiani Pakistan
  • Robert PalmerUnited States of America
  • Hiroaki TakahashiJapan
  • Herlina UinarniIndonesia
    VCU Department of Thoracic Imaging Virginia Commonwealth University VCU Medical Center