Cardiogenic pulmonary edema - unilateral

Case contributed by Dr Mohamed Mahmoud Elthokapy

Presentation

Known cardiac patient with previous coronary stenting presented with severe typical chest pain, radiating to left shoulder with marked dyspnea. ECG revealed elevated ST-segment and labs showed high troponin levels.

Patient Data

Age: 35 years
Gender: Male

Initial study

x_ray

Right asymmetrical airspace consolidation in a central peri-bronchovascular distribution sparing the apices and basal regions. Pleural spaces appear clear. Slightly prominent cardiac shadow.

CT chest

ct

Bilateral (mainly right) pulmonary interstitial and air space diseases more prominent at the central perihilar areas and lung bases presenting as thickened interlobular septa, pulmonary reticulations as well as confluent patchy areas of alveolar opacities and consolidative patches showing preserved bronchial markings.

Bilateral rim of minimal pleural effusion.

Mild pericardial effusion.

Changes related to previous coronary stenting.

Upper abdominal cuts revealed congested renal parenchyma (mainly left-sided) and mild hepatomegaly.

2 days later

x_ray

Two days after the first plain film, with the patient under treatment, there is a mild regressive course regarding previously seen right air space consolidative opacity.

Case Discussion

Features are those of nonspecific right and to a lesser extent left airspace opacities, with differentials including pulmonary edema, infection, and pulmonary hemorrhage. The previous cardiac history, elevated ST-segment and high troponin level with mild pericardial effusion, hepatomegaly, and renal congestion guided us for cardiogenic pulmonary edema as the likely cause, however other possibilities couldn't be totally excluded.

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