What is the clinical evidence from this study?

Study design: Case Report. Population: Diffuse alveolar hemorrhage and acute mitral regurgitation (n=1). Intervention: Medical management and scheduled mitral valve replacement.

What does this research mean for the field?

Acute mitral regurgitation can rarely present initially as diffuse alveolar hemorrhage, necessitating the consideration of cardiac etiologies and early echocardiography in unexplained cases. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This case highlights the unusual presentation of diffuse alveolar hemorrhage as a first sign of acute mitral regurgitation.

May 29, 2026Open Access

Diffuse Alveolar Hemorrhage as a First Presentation for Acute Mitral Regurgitation: Case Report

Key Result

A 58-year-old man presented with diffuse alveolar hemorrhage as the initial manifestation of acute mitral regurgitation due to ruptured chordae tendineae.

Key Points

This case highlights the unusual presentation of diffuse alveolar hemorrhage as a first sign of acute mitral regurgitation.
Case report of a 58-year-old man with dyspnea and cough presenting with DAH.
Diagnostic imaging included HRCT and TEE, and BAL was performed to confirm DAH.
Patient history and examinations indicated acute mitral regurgitation from posterior leaflet prolapse.
NT-proBNP level was abnormal at 165 ng/L indicating possible heart failure.
HRCT revealed bilateral ground-glass opacities, consistent with DAH.
TEE confirmed moderate-to-severe acute MR, leading to mitral valve replacement.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 58-year-old man with type 2 diabetes mellitus and hypertension presenting with dyspnea and cough with pink-stained white sputum for two days.

Intervention

Diagnostic workup including transesophageal echocardiography and bronchoalveolar lavage, followed by scheduling for mitral valve replacement.

Outcome

Diagnosis of acute mitral regurgitation and diffuse alveolar hemorrhage.

Acute mitral regurgitation should be considered as a potential cardiac etiology in patients presenting with unexplained diffuse alveolar hemorrhage.

Limitations

Single case report limits generalizability
Further large-scale observational studies are needed to explain the paradoxically low NT-proBNP level despite acute mechanical valvular failure

Abstract

Diffuse alveolar hemorrhage (DAH) is a medical emergency that is known to be caused by systemic vasculitis, autoimmune conditions, coagulation disorders, and toxins. While it can be caused by chronic mitral regurgitation (MR), it has a rare association with acute MR. We report the case of a patient presenting with DAH as the first sign of acute MR. A 58-year-old man with type 2 diabetes mellitus and no cardiac history except for hypertension presented with dyspnea and cough with pink-stained white sputum for two days. On examination, bilateral crepitations and a pansystolic murmur were noticed. N-terminal pro-B-type natriuretic peptide (NT-proBNP) was 165 ng/L, while high-resolution computed tomography (HRCT) showed diffuse bilateral ground-glass opacities with a crazy paving pattern. Transesophageal echocardiography (TEE) showed preserved left ventricular ejection fraction (>60%) and confirmed moderate-to-severe eccentric acute MR due to posterior leaflet prolapse with rupture of marginal chordae tendineae. Bronchoalveolar lavage (BAL) confirmed alveolar hemorrhage and established the diagnosis of DAH, which initially mimicked severe respiratory infection due to the presence of pink-stained sputum and bilateral infiltrates. Following stabilization, the patient was scheduled for mitral valve replacement. This case illustrates the importance of considering cardiac etiologies and performing early echocardiography in patients presenting with unexplained DAH, as these etiologies can mimic common causes of DAH.

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