Case contributed by Dr Ammar Ashraf


Respiratory distress for 1 day, mainly at night. No chest pain, palpitations, fever, cough, syncope, or dizziness.

Patient Data

Age: 90 years
Gender: Female

A medical device (two metallic clips) is seen projecting over the cardiac shadow, likely in the region of the mitral valve. Cardiomegaly with hilar vascular congestion and interstitial pulmonary edema. No sizable pleural effusion/pneumothorax is seen. Generalized osteopenia is noted in the visualized skeleton. A wedge compression fracture of one of the mid-dorsal vertebra is also noted.


Findings: Cardiomegaly with enlargement of the left atrium. A dense mitral valve prosthesis (MitraClip) is seen in place. Patchy areas of ground glassing are seen in both lungs which may be due to pulmonary edema. Mild bilateral apical pleural thickening, suggestive of previous chronic granulomatous infection. Multiple prominent partially calcified mediastinal lymph nodes are seen. The trachea is patent and well aerated. Diffuse osteopenia is noted in the visualized skeleton. Decreased body height of the 8th dorsal vertebra is noted without any retropulsion. A few surgical clips are seen in the thyroid bed (history of total thyroidectomy). 

Case Discussion

  • Past medical history: Ischemic cardiomyopathy, chronic atrial fibrillation, hypertension,  percutaneous coronary intervention (PCI) for coronary artery disease, and hypothyroidism.
  • Previous echocardiography: Mildly dilated LV with severe systolic dysfunction, akinesia of LAD territory, and an ejection fraction of 20-25%. Moderate mitral stenosis & mitral regurgitation, mild to moderate aortic valve regurgitation, and mild tricuspid regurgitation.
  • Due to her age and multiple risk factors, mitral regurgitation was treated with Mitraclip device.
  • CT chest was requested to rule out any central airway abnormality, as the cause of her respiratory distress. 

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