CTICasesAcute Mitral Regurgitation with Asymmetric Right Upper Lobe Pulmonary Edema
[...]. Acute Mitral Regurgitation with Asymmetric Right Upper Lobe Pulmonary Edema. CTICases. Published July 2, 2021. https://str-case-explorer.pages.dev/c/g7wp8
Imaging findings
Chest radiograph and chest CT demonstrate asymmetric pulmonary edema predominantly concentrated in the right upper lobe, with extensive septal lines representing interstitial edema, patchy ground-glass opacity indicating alveolar edema, and bilateral pleural effusions.
Key takeaways
Acute severe mitral regurgitation, often caused by chordae tendineae rupture of the posterior leaflet, can produce an eccentric, high-velocity regurgitant jet directed straight into the right superior pulmonary vein. This hemodynamically drives severe, asymmetric, right upper lobe-predominant pulmonary edema. Extremely high capillary pressures can cause "stress failure" of the alveolar-capillary barrier, leading to a protein-rich alveolar injury that clears more slowly than standard hydrostatic edema after surgical repair.
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