Chest
Volume 103, Issue 4, April 1993, Pages 1286-1288
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Selected Reports
Right Upper Lobe Pulmonary Edema Caused by Acute Mitral Regurgitation: Diagnosis by Transesophageal Echocardiography

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Unilateral pulmonary edema is a distinctly unusual clinical entity, often misdiagnosed initially as one of the more common causes of focal lung disease. Predominantly lobar pulmonary edema is rarer still. We report a case of right upper lobe pulmonary edema caused by the acute onset of severe mitral regurgitation. In addition, we briefly review the other causes of unilateral pulmonary edema, focusing on the cases that have been reported in association with heart failure and valvular heart disease. The majority of cases of right upper lobe pulmonary edema have been associated with mitral regurgitation. In addition to confirming the presence of mitral regurgitation, transesophageal echocardiography proved useful in delineating the mechanism for edema formation. It detected differential gradients between the right and left pulmonary venous systems and documented the direction of the regurgitant flow.

Section snippets

CASE REPORT

A 73-year-old white man presented with the complaints of the acute onset of chest pain, “achey” muscles and fevers to 39.3°C. He sought medical attention and a new grade 4/6 holosystolic murmur was noted; he was admitted to the hospital to evaluate the possibility of subacute bacterial endocarditis. Medical history was significant only for mitral valve prolapse documented by echocardiography in 1986. Physical examination revealed a well-developed, well-nourished white man in no distress. Vital

DISCUSSION

Though uncommon, unilateral pulmonary edema (UPE) has been reported in association with several different clinical situations (Table 1). Focal imbalance of Starling forces is the common thread that unites this wide variety of etiologies. “Reexpansion” pulmonary edema, which occasionally occurs following thoracentesis or treatment of a pneumothorax, accounts for the majority of reported cases.3, 4, 5, 6, 7, 8, 9 Several cases have also been reported in the recent literature in association with

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The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army, Uniformed Services University of the Health Sciences, or the Department of Defense.

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