Key result
An 88-year-old female with critical aortic stenosis and severe mitral regurgitation developed unilateral diffuse alveolar hemorrhage, likely due to the selective directionality of the mitral regurgitant jet.
Why the study?
Diffuse alveolar hemorrhage in cardiac disease typically causes bilateral infiltrates, but rarely presents unilaterally, mimicking infectious pneumonia and leading to diagnostic error.
Case Report (n=1)
Unilateral diffuse alveolar hemorrhage is a rare, potentially fatal complication of severe mitral regurgitation and aortic stenosis that can mimic pneumonia and requires prompt diagnosis via bronchoscopy.
Unilateral DAH should be considered in cardiac patients with asymmetric infiltrates; extends the recognized spectrum but remains hypothesis-generating.
Diffuse alveolar hemorrhage (DAH) in cardiac diseases results from pulmonary capillary stress failure due to pulmonary venous hypertension. The most common cardiac causes of DAH are heart failure and mitral valvular disease. Patients typically manifest with hemoptysis, radiologic chest abnormalities, and anemia. The chest infiltrates are generally bilateral, similar to pulmonary edema. Rarely, the chest infiltrates can be unilateral, mimicking an infectious etiology. We present the case of an 88-year-old female with critical aortic stenosis, who presented with shortness of breath, unilateral right lung infiltrates, and mild leukocytosis. The patient was misdiagnosed with pneumonia as pulmonary edema or DAH was expected to be a bilateral finding on chest imaging. The patient deteriorated and DAH was eventually diagnosed by bronchoscopy.
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Saha et al. (2021) conducted a case report in Unilateral diffuse alveolar hemorrhage, severe aortic stenosis, severe mitral regurgitation (n=1). Severe mitral regurgitation and critical aortic stenosis was evaluated. An 88-year-old female with critical aortic stenosis and severe mitral regurgitation developed unilateral diffuse alveolar hemorrhage, likely due to the selective directionality of the mitral regurgitant jet.
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