Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction

Shin, Junho; Kim, Seok Hwan; Park, Jin‐Kyu; Lim, Young‐Hyo; Park, Hwan Cheol; Choi, Sung Il; Shin, Jinho; Kim, Kyung Soo; Kim, Soon Gil; Hong, Mun K.; Lee, Jae-Ung

doi:10.3346/jkms.2012.27.2.211

Cited by 13 publications

(16 citation statements)

References 12 publications

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“…2 Due to this low incidence it is usually missed, causing initiation of wrong treatment or delay in appropriate treatment in up to 33% of cases. 2,3 This delay contributes to an almost 7-fold increase in mortality when compared with patients presenting with bilateral pulmonary edema. 2 Disease entities and factors that could mimic or cause unilateral pulmonary edema include pneumonia (including aspiration), patient positioning, bronchial or pulmonary vein obstruction, pulmonary contusion or infarction, alveolar hemorrhage, or malignancy.…”

Section: Discussionmentioning

confidence: 98%

‘Atypical Pneumonia’: Acute Mitral Regurgitation Presenting with Unilateral Infiltrate

Ogunbayo

Thambiaiyah

Ojo

et al. 2015

The American Journal of Medicine

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Section: Discussionmentioning

confidence: 98%

‘Atypical Pneumonia’: Acute Mitral Regurgitation Presenting with Unilateral Infiltrate

Ogunbayo

Thambiaiyah

Ojo

et al. 2015

The American Journal of Medicine

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“…UPE has been reported after congestive heart failure, prolonged rest on one side in patients with cardiac decompensation or receiving large amounts of fluids, in cases of rapid expansion of the lungs after pleural effusion, and pneumothorax [ 5 – 7 ]. It is also seen in a normal lung in patients with unilateral pulmonary disease such as MacLeod syndrome and unilateral pulmonary artery hypoplasia or agenesis, pulmonary artery compression from aortic dissection or LV pseudo aneurysm, and pulmonary venous obstruction from mediastinal fibrosis [ 1 ]. However, it is mainly reported in association with severe MR [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Unilateral pulmonary edema (UPE) is uncommon, accounting for 2% of cardiogenic pulmonary edemas, and usually involves the upper lobe of the right lung [ 1 ]. The mechanism of UPE has been attributed to various causes [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Unilateral pulmonary edema: a case report and review of the literature

Handagala¹,

Ralapanawa

Jayalath³

2018

J Med Case Reports

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BackgroundUnilateral pulmonary edema is an uncommon condition and is a rare clinical entity that is often misdiagnosed at the initial stages. In a majority of patients it occurs in the upper lobe of the right lung. There are many causes of unilateral pulmonary edema, but the commonest is the presence of a grade 3 mitral regurgitation. Due to its rare presentation, a high index of suspicion is required, and correct management is necessary to reduce the morbidity and mortality.Case presentationWe present a case of right-sided unilateral pulmonary edema in an 86-year-old Sinhalese Sri Lankan woman who presented with acute onset dyspnea with cardiogenic shock due to acute non-ST elevation myocardial infarction, complicated with grade 3 mitral regurgitation. She had clinical features of heart failure and pulmonary edema, but a chest X-ray showed unilateral infiltrates only on the right side. Distinguishing pneumonia from pulmonary edema according to chest X-ray findings was a challenge initially, and she was therefore initially treated for both conditions. She had remarkable clinical and radiological improvement after 12 hours of intravenously administered furosemide and glyceryl trinitrate therapy. Her brain natriuretic peptide level was elevated and further supported and confirmed the diagnosis retrospectively.ConclusionsUnilateral pulmonary edema is a completely reversible condition with good patient outcome if it is suspected early and treated early. Even in the absence of readily available echocardiogram skills, a clinical examination is of paramount importance in making a clinical decision in low-resource settings to reduce mortality.

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“…For example, it has been reported that right lung pulmonary congestion due to heart failure is significantly related to severe mitral regurgitation, and the pathogenesis of this condition is believed to involve the velocity vector of the regurgitant blood flow directed toward the right pulmonary veins (16). However, right-sided pulmonary congestion may also be present in patients with acute cardiac decompensation without mitral regurgitation (17). Since both pulmonary congestion and bland DAH associated with cardiac disorders result from increased capillary pressure, both may occur on the right side predominantly.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Alveolar Hemorrhage with Predominantly Right-sided Infiltration Resulting from Cardiac Comorbidities

et al. 2015

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Objective Radiographic findings in patients with diffuse alveolar hemorrhage (DAH) are usually diffuse and bilateral, although they may occasionally be unilateral. The clinical aspects of predominantly unilateral DAH are not well known. Therefore, our objective was to describe the clinical characteristics of predominantly right-sided DAH. Methods We retrospectively reviewed data for 460 bronchoalveolar lavage fluid (BALF) samples collected between January 2009 and July 2013. Patients who presented with increasingly hemorrhagic BALF were diagnosed with DAH, and unilateral predominance was determined based on the degree of infiltration on chest radiographs. Results The records of 54 patients with DAH were evaluated. The leading etiology was pulmonary congestion due to heart failure (n=15). The radiographs showed right-sided infiltration in 18 patients (33%), leftsided infiltration in six patients (11%) and bilateral infiltration in 30 patients (56%). Predominantly rightsided DAH was often caused by pulmonary congestion resulting from heart failure (10 of 18 patients). A multivariate logistic regression analysis revealed a previous history of cardiovascular disease to be the only significant predictor of right-sided DAH (OR 13.1, 95% CI 2.9-95.4). Conclusion Predominantly right-sided DAH is frequently caused by pulmonary congestion resulting from heart failure and is significantly related to comorbidities with cardiovascular disease.

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Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction

Cited by 13 publications

References 12 publications

‘Atypical Pneumonia’: Acute Mitral Regurgitation Presenting with Unilateral Infiltrate

‘Atypical Pneumonia’: Acute Mitral Regurgitation Presenting with Unilateral Infiltrate

Unilateral pulmonary edema: a case report and review of the literature

Diffuse Alveolar Hemorrhage with Predominantly Right-sided Infiltration Resulting from Cardiac Comorbidities

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