CTICasesAsymmetric Right Lung Edema from Acute Mitral Regurgitation with Flail Leaflet
[...]. Asymmetric Right Lung Edema from Acute Mitral Regurgitation with Flail Leaflet. CTICases. Published September 19, 2026. https://cticases.com/c/ygg3k
Imaging findings
A woman in her early thirties presented with shortness of breath. The emergency department radiograph and the next-day follow-up showed a persistent opacity in the right lung, and comparison with an old radiograph showed that the heart had enlarged. The opacity was interpreted as selective right lung edema from mitral regurgitation, and echocardiography confirmed a flail mitral leaflet with the regurgitant jet directed toward the right lung. After mitral valve replacement, radiographs a few days later showed resolution of the edema.
Key takeaways
Unilateral or right upper lobe predominant pulmonary edema can result from an eccentric mitral regurgitant jet directed into the right pulmonary veins, and it closely mimics pneumonia. In a young woman heart disease is easy to overlook, but mitral valve disease need not be atherosclerotic, and comparison with an old radiograph showing interval cardiac enlargement is the key clue. This patient was about to be discharged from the emergency department when the radiologist raised the possibility of a cardiac cause with the consulting pulmonologist, and echocardiography before discharge led almost immediately to surgery. Direct communication of an alternative diagnosis changed management.
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