Unilateral pulmonary edema

Q: Unilateral cardiogenic pulmonary edema in acute decompensated heart failure (ADHF) is most likely due to? (select one) 

A) Pulmonary embolism (PE) 
B) Mitral regurgitation 
C) Chronic pulmonary hypertension 
D) Cirrhosis 
E) Blunt trauma to pericardium


Answer: B

Chest X-ray (CXR) remained a mainstay of diagnostic workup in acute decompensated heart failure. Classic teaching of having  "butterfly" appearance from bilateral interstitial markings is still very valid but it needs to be known that about 20% of patients in ADHF may have a normal CXR, and about 2% may have an unilateral cardiogenic pulmonary edema and the cause is mostly eccentric mitral regurgitation proved otherwise.

#Cardiology


References:

1. Attias D, Mansencal N, Auvert B, et al. Prevalence, characteristics, and outcomes of patients presenting with cardiogenic unilateral pulmonary edema. Circulation 2010; 122:1109. 

2. Wang CS, FitzGerald JM, Schulzer M, et al. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA 2005; 294:1944.