Key result
Polypragmatic treatment including diuretics and inotropes resulted in prompt radiographic resolution of right-sided consolidations, revealing underlying pulmonary venous congestion and interstitial edema.
Case Report (n=1)
No
Unilateral cardiogenic pulmonary edema can mimic pneumonia, particularly in patients with severe mitral valve insufficiency, but rapid radiographic resolution with diuretic therapy helps distinguish it from infection.
Unilateral consolidations may represent cardiogenic edema in mitral regurgitation; case report leaves open prospective validation.
An 88-year old man was admitted to our emergency department with acute onset of dyspnea, non-productive cough and respiratory failure. 6 weeks before presentation, the patient had undergone percutaneous mitral valve clipping (Panel A, arrow) for severe mitral valve insufficiency due to prolaps and flail posterior leaflet. The patient's history was remarkable for mitral valve endocarditis (viridians streptococci) more than ten years before clipping, coronary artery sclerosis without relveant stenosis, persistent atrial fibrillation and latent hypothyroidism. The patient's medication included, inter alia, oral anticoagulation with rivaroxaban for atrial fibrillation, loop diuretics (torasemid), a mineralocorticoid receptor antagonist (aldactone), an angiotensin-converting enzyme inhibitor (perindopril) a cardio-selective betablocking agent (bisoprolol) and proton pump inhibitor therapy (pantoprazol). Adherence to medication was reported to be good.
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Lars C Huber (2017) conducted a case report in Acute cardiogenic pulmonary edema (n=1). Polypragmatic treatment (diuretics, inotropes, antibiotics, steroids, noninvasive ventilation) was evaluated on Clinical and radiographic improvement. Polypragmatic treatment including diuretics and inotropes resulted in prompt radiographic resolution of right-sided consolidations, revealing underlying pulmonary venous congestion and interstitial edema.
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