Journal of General Internal Medicine

, Volume 26, Issue 9, pp 1075–1076

Mitral Regurgitation and Pulmonary Edema

Open AccessClinical Practice: Clinical Images

DOI: 10.1007/s11606-011-1661-5

Cite this article as:
Shah, A.D., Foster, E. & Cucina, R.J. J GEN INTERN MED (2011) 26: 1075. doi:10.1007/s11606-011-1661-5

Key words

mitral regurgitationpulmonary edemapulmonary vein

Report of case

An asymptomatic 88-year-old Asian male with hypertension presented with a right upper lobe infiltrate on chest x-ray. A chest CT (Fig. 1) demonstrated a geographic 3.5 × 2.2-cm ground-glass opacity in the right apex. A 3/6 holosystolic murmur was heard at the apex radiating to the axilla. Transthoracic echocardiography showed a flail posterior mitral valve leaflet secondary to a ruptured chordae tendinae.
https://static-content.springer.com/image/art%3A10.1007%2Fs11606-011-1661-5/MediaObjects/11606_2011_1661_Fig1_HTML.gif
Figure 1

Chest CT image.

In patients with a flail posterior mitral valve leaflet, the regurgitant jet is directed towards the right superior pulmonary vein1 (Fig. 2), causing higher hydrostatic pressures in that location. This may lead to focal edema in the right upper lobe2. Prior studies have shown that up to 38% of patients with a ruptured chordae tendinae remain asymptomatic in the subacute to chronic setting despite severe mitral insufficiency3,4. In most cases, surgical repair is highly successful5. However, given this patient’s age and his excellent response to medical therapy with an angiotensin receptor blocker, surgery was not performed. In the setting of upper lobe infiltrates where infection and cancer seem unlikely or have been excluded, mitral regurgitation with segmental pulmonary edema should be considered.
https://static-content.springer.com/image/art%3A10.1007%2Fs11606-011-1661-5/MediaObjects/11606_2011_1661_Fig2_HTML.gif
Figure 2

The mitral regurgitant jet is directed towards the right superior pulmonary vein.

Contributor

Gurpreet Dhaliwal, MD.

Funders

None.

Prior Presentation

Presented as a clinical vignette poster at the Society of General Internal Medicine National Meeting on April 29, 2010.

Conflict of Interest

None disclosed.

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Copyright information

© The Author(s) 2011

Authors and Affiliations

  • Arti D. Shah
    • 1
  • Elyse Foster
    • 2
  • Russell J. Cucina
    • 3
  1. 1.Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Division of CardiologyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Division of Hospital MedicineUniversity of California San FranciscoSan FranciscoUSA