Pulmonary oedema caused by STEMI

Case contributed by Dr Balint Botz

Presentation

Rapidly developing dyspnea and confusion. Anteroseptal ST elevation on EKG. Extremely high troponin, moderately elevated CRP.

Patient Data

Age: 75
Gender: Male
X-ray

Supine CXR

Bilateral perihilar haze, prominent upper pulmonary veins, diffuse alveolar (ill-defined opacities) and interstitial oedema (Kerley B lines in the basal lung zones - see key image). Prominent horizontal fissure suggesting a small pleural effusion on the right.

Case Discussion

The patient demonstrated classic features of pulmonary oedema including the bat's wing appearance of the hila, alveolar and insterstitial oedema, upper lobe venous diversion, and a small amount of pleural effusion.

Consequent urgent echocardiography demonstrated an akinetic ventricular septum, decreased left ventricular function, and moderate mitral valve insufficiency. Considering all this the pulmonary oedema was caused by the ongoing acute myocardial infarction whilst considering the elevated CRP an overlapping inflammatory component cannot be ruled out.

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Case information

rID: 57006
Case created: 2nd Dec 2017
Last edited: 4th Dec 2017
Systems: Chest, Cardiac
Inclusion in quiz mode: Included
Institution: University of Pécs

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