CTICasesAcute Mitral Regurgitation with Asymmetric Right Upper Lobe Pulmonary Edema
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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