CXR in ADHF

 Q: Presence of unilateral pulmonary edema on chest X-ray (CXR) points toward which valvular heart disease?

A) mitral regurgitation 

B) mitral stenosis 

C) aortic regurgitation 

D) aortic stenosis 

E) tricuspid regurgitation

Answer: A

CXR finding in acute decompensated heart failure (ADHF) usually consists of bilateral interstitial markings in a well-known "butterfly" pattern. Other typical findings in CXR are cardiomegaly, peribronchial cuffing, and interlobular septal thickening. Blood flow pattern and alveolar edema pattern also provides a clue. There is usually an upper zone redistribution of blood flow with alveolar edema mostly filling the perihilar and lower-lobe airspace, and the periphery generally spared in the mid and upper lung zones. 

 In case, signs of ADHF are present but CXR shows unilateral pulmonary edema, it is most probably caused by an eccentric mitral regurgitation.

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References:

1. Cardinale L, Volpicelli G, Lamorte A, et al. Revisiting signs, strengths and weaknesses of Standard Chest Radiography in patients of Acute Dyspnea in the Emergency Department. J Thorac Dis 2012; 4:398. 

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