CTPA performed 6 months earlier for similar presentation of acute shortness of breath shows consolidation in the posterior segment of the right upper lobe (green *). Evidence of unilateral lobar venous congestion with enlargement of the right upper lobe pulmonary vein (yellow arrow) and more specifically the posterior segmental branch (red arrow).
Evidence of elevated right atrial pressure with contrast reflux into the hepatic veins. Mitral annulus calcification noted but no gross left atrial enlargement.
Transthoracic echo shows normal cardiac valves, no right atrial dilation and only mild left atrial dilation. Normal ejection fraction of 55-60%. However, there is moderate to severe diastolic dysfunction with elevated diastolic filling pressure.
Unilateral pulmonary involving the right upper lobe has been demonstrated to have strong correlation with severe with mitral valve regurgitation. However, in this example the mitral vale is normal.