https://orcid.org/0009-0006-4684-9765
A 61-year-old male presented to the hospital with a 1-week history of dyspnoea and cough without sputum. His oxygen saturations (SpO2) were 85% on room air and 96% on 4 L of oxygen. He was afebrile, normotensive, and his heart rate was normal. Auscultation of his chest revealed right-sided crepitations. Chest X-ray (CXR) demonstrated diffuse right-sided opacities (Panel A). Laboratory tests revealed mild neutrophilia and elevated C-reactive protein (69 mg/L, reference <5 mg/L). Intravenous clavulanate/amoxicillin and oral clarithromycin were commenced to treat possible pneumonia. However, induced sputum and blood cultures were unremarkable. Twelve hours after admission, he deteriorated and became tachycardic, diaphoretic, and tachypnoeic. His SpO2 was 90% breathing 100% oxygen. Computerized tomography pulmonary angiography excluded pulmonary embolism (PE) but demonstrated right-sided consolidation and moderate right-sided pleural effusion. Electrocardiogram demonstrated sinus tachycardia. Transthoracic echocardiography showed a flail posterior mitral leaflet (Panel B) causing severe mitral regurgitation (MR) (Panel C) and unilateral pulmonary oedema. Percutaneous coronary angiography excluded a possible ischaemic aetiology. The patient was stabilized with continuous positive airway pressure and intravenous diuretics before undergoing emergency mitral valve replacement. He had an excellent response with interval resolution of the CXR findings (Panel D).
Unilateral cardiogenic pulmonary oedema is rare. It is commonly misdiagnosed, mimicking pulmonary disease, and has a high mortality rate. It is most commonly caused by severe MR, where the regurgitant jet is directed towards the right pulmonary veins causing focal pulmonary congestion.1 Other causes include re-expansion pulmonary oedema, pulmonary venous pathologies, and PE.2 Management involves diuresis but definitive treatment requires correction of the underlying cause.
Supplementary data are not available at European Heart Journal online.
All authors declare no disclosure of interest for this contribution.
No data were generated or analysed for or in support of this paper.
