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Cardiovascular Disease |

Unilateral Pulmonary Edema: An Unusual Cause of Nonresolving Right-Sided Consolidation

Jessica Quah, MMed; Tan Keng Leong, MMed
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Singhealth Singapore, Singapore, Singapore


Chest. 2014;145(3_MeetingAbstracts):61A. doi:10.1378/chest.1823725
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Abstract

SESSION TITLE: Cardiovascular Case Report Posters I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Cardiogenic pulmonary edema occurring unilaterally is rare and presents diagnostic difficulties.

CASE PRESENTATION: A 72 year-old male presented with persistent right lower zone consolidation. He had a background of ischaemic heart disease with mitral regurgitation requiring coronary artery bypass surgery and mitral annuloplasty. A recent echocardiography revealed markedly impaired left ventricular ejection fraction of 16%, with mild mitral regurgitation and stenosis. He presented initially with fever, cough and right lower zone consolidation on chest radiography. Diagnosis of community-acquired pneumonia was made and he received antibiotics. Three months later, he continued to experience persistent cough with exertional dyspnea. Investigations revealed blood leukocytosis of 15.36 x 106/ul with neutrophilic predominance. Blood serologies and sputum bacteriologies did not reveal any causative organisms. Chest radiography showed persistent right lower zone consolidation. Computed tomography of the thorax revealed bilateral pleural effusions, unilateral right-sided ground glass changes with consolidative changes in the right lower lobe. Cardiomegaly was demonstrated with preferential left ventricular and atrial dilatation associated with prominent mitral annulus calcifications.The patient received an increased dose of diuretics with symptomatic improvement and radiological resolution.

DISCUSSION: Unilateral cardiogenic pulmonary edema (UCPE) has been described in association with severe mitral regurgitation [1], congestive heart failure [2], peripartum cardiomyopathy [3] and unilateral pulmonary artery hypoplasia. UCPE is commonly associated with mitral regurgitation due to a regurgitant jet affecting the right pulmonary veins resulting in an increase in mean capillary pressures of the right lung. A case series of UCPE secondary to mitral regurgitation by Attias et al [1] showed that delay in appropriate treatment was frequent and associated with increased risk of mortality. UCPE has also been described in left ventricular failure. In a case series of 12 pregnant women, Choi et al [3] described underlying etiologies of peripartum cardiomyopathy and mitral stenosis. These patients were initially misdiagnosed with pneumonia with mean delay to treatment of 4-5 days.

CONCLUSIONS: UCPE is an uncommon presentation; it should be considered in patients with unilateral pulmonary infiltrates and severely impaired left ventricular function or mitral valve diseases to avoid delay in diagnosis and appropriate treatment.

Reference #1: Attias D, Mansencal N. Prevalence, characteristics, and outcomes of patients presenting with cardiogenic unilateral pulmonary edema. Circulation. 2010;122:1109-1115.

Reference #2: Nitzan O, Saliba WR, Goldstein LH. Unilateral pulmonary edema: a rare presentation of congestive heart failure. Am J Med Sci. 2004; 327: 362-364

Reference #3: Choi HS, Choi H, Han S, et al. Pulmonary edema during pregnancy: unilateral presentation is not rare. Circ J 2002;66:623-6

DISCLOSURE: The following authors have nothing to disclose: Jessica Quah, Tan Keng Leong

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