Unilateral pulmonary edema from mitral regurgitation

Case contributed by Dr Haiying Chen

Presentation

Sudden onset dyspnea with hypoxia

Patient Data

Age: 40 years
Gender: Female

There is marked increase in alveolar opacity predominantly in the right mid to lower zones compared to the chest X-ray performed one day prior. Straightening of the left atrial appendage and splaying of the carina are consistent with left atrial enlargement. 

Transthoracic echocardiogram demonstrated mitral regurgitation, represented by the blue jet of blood directed from the left ventricle (top right chamber) to the left atrium (bottom right chamber) in systole. The mitral regurgitation was due to chordal rupture and prolapse of the posterior leaflet of the mitral valve.

Case Discussion

Patient underwent urgent mitral valve repair after having a normal coronary angiogram.

Acute decompensated mitral regurgitation can present with unilateral pulmonary edema, which is predominantly observed in the right lung. This is thought to be related to the direction of the regurgitant jet towards the right pulmonary veins 1

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