Rare roentgenologic manifestations of pulmonary edema

Acute Heart Failure With Unilateral Pulmonary Edema Due to Aortic Insufficiency During LVAD Support

Unilateral pulmonary edema (UPE) is a rare manifestation of cardiogenic pulmonary edema that is often confused with other causes of unilateral pulmonary infiltrates. A 47-year-old female with a HeartWare left ventricular assist device (LVAD) presented with dyspnea and UPE. Right heart catheterization revealed inadequate left ventricular unloading in the setting of aortic insufficiency and facilitated LVAD speed adjustment leading to resolution of symptoms. Timely diagnosis of UPE is critical because it is related to an independent increased risk of mortality, likely due to initial misdiagnosis and delayed proper treatment. The increasing use of LVADs in patients with advanced heart failure necessitates a thorough understanding of potential device complications and their management.

An 80-year-old man with a right upper lobe opacity

BACKGROUND AND AIMS

The differential diagnosis of a right upper lobe pulmonary opacity in an elderly afebrile patient includes infectious and malignant etiology. However, unilateral lung edema should also be included in the differential diagnosis.

METHODS

Case report of an 80-year-old afebrile patient who presented with cough, dyspnea and blood-tinged sputum and had an isolated right upper lobe infiltrate on chest X-ray on whom a diagnostic work-up including computed tomography scan of the chest and echocardiography was performed.

RESULTS

Bilateral alveolar opacities and pleural effusions, not apparent on the chest X-ray, and a flail posterior leaflet with severe mitral valve regurgitation were revealed. His symptoms and findings responded to diuretic treatment.

CONCLUSION

Pulmonary edema should be considered in a patient with mitral valve regurgitation presenting with a unilateral lung infiltrate. Chest computed tomography scan findings consistent with heart failure and echocardiography demonstrating mitral valve regurgitation are the main clues to the diagnosis. Diuretic therapy should cause a rapid improvement of the radiologic and clinical findings.