Asymmetric Pulmonary Edema Due to Acute Eccentric Mitral Regurgitation Based on Pulmonary Vein Distribution

BACKGROUND: Acute eccentric mitral regurgitation (MR) is known to cause unilateral pulmonary edema. CASE SUMMARY: A 63-year-old previously healthy woman presented with dyspnea and asymmetrical pulmonary infiltrates. Unlike the typical unilateral presentation, these infiltrates showed regional stratification across all 4 lung fields. Her condition worsened despite the administration of antibiotics. Echocardiography revealed severe eccentric MR caused by mitral valve prolapse and chordal rupture. Blood flow patterns in the 4 pulmonary veins corresponded to the intensity of pulmonary infiltrates in their respective lung fields. She was diagnosed with acute heart failure due to acute MR, and her condition improved following intensive treatment. DISCUSSION: This case highlights that the direct inflow of an MR jet into the pulmonary veins play a crucial role in asymmetrical pulmonary edema. TAKE-HOME MESSAGE: Recognizing the correspondence between asymmetrical pulmonary edema and acute MR may facilitate timely and accurate diagnosis of acute heart failure due to acute MR.