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(Circulation. 2007;115:e206-e207.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

Localized Pulmonary Edema After Blunt Chest Trauma

Shougo Murakami, MD; Michihiro Suwa, MD; Hideaki Morita, MD; Tomoe Murakami, MD; Takahide Ito, MD; Akiko Soyama, MD; Tatsuji Kono, MD; Yasushi Kitaura, MD; Takahiro Katsumata, MD

From the Third Department of Internal Medicine (S.M., M.S., H.M., T.M., T.I., A.S., T. Kono, Y.K.), and the Department of Thoracic and Cardiovascular Surgery (T. Katsumata), Osaka Medical College, Takatsuki-city, Osaka, Japan.

Correspondence to Shougo Murakami MD, The Third Department of Internal Medicine, Osaka Medical College, 2–7, Daigakumachi, Takatsuki-city, Osaka, 569–8686, Japan. E-mail Shougo17{at}gb3.so-net.ne.jp

Although it is well recognized that acute mitral regurgitation (MR) is caused by acute myocardial infarction and infective endocarditis, blunt chest trauma is also, albeit rarely, reported as the cause. In most cases, acute MR provokes pulmonary edema and hemodynamic deterioration. We report a case of a 45-year-old man with atypical pulmonary edema caused by acute traumatic MR.

The patient fell down the stairs and injured his chest. After a few days, he visited his primary physician because of progressive chest pain and dyspnea. A new grade 3/6 systolic regurgitant murmur radiated toward the upper sternal border and was noted at the apex of the heart, and he was referred to our hospital.

In the emergency room, 2-dimensional and color Doppler echocardiography revealed massive MR attributable to ruptured chordae tendineae of posterior leaflet (Movie I). A chest roentgenogram revealed pulmonary infiltration, predominantly in the right upper lobe (Figure 1). Pulmonary edema worsened bilaterally a few days later, and the mitral valve was surgically repaired.

View larger version (125K): [in this window] [in a new window]   Figure 1. Chest roentgenogram on admission showing pulmonary infiltration, predominantly in the right upper lobe.

In a few cases of acute MR, pulmonary edema localized in the right upper lobe has been reported. As the underlying mechanism, it has been suggested that the MR jet is oriented toward the right upper pulmonary vein, accentuating the forces for edema formation in the right upper lobe. In our patient, color and pulsed Doppler echocardiography showed that the regurgitant jet reached the orifice of the right upper pulmonary vein along the interatrial septum (Movie II and Figure 2).

View larger version (73K): [in this window] [in a new window]   Figure 2. Pulsed Doppler image demonstrating systolic reversal of flow into the right upper pulmonary vein.

In this case, acute MR was caused by blunt chest trauma. Although isolated traumatic MR is rare, it is difficult to distinguish pulmonary edema from pulmonary contusion using a chest roentgenogram. This case may alert clinicians to the possibility of unilateral pulmonary edema accompanying MR.

	Acknowledgments

 
Disclosures

None.

	Footnotes

 
The online-only Data Supplement, consisting of movies, is available with this article at http://circ.ahajournals.org/cgi/content/full/115/8/e206/DC1.

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Murakami, S. Articles by Katsumata, T. Search for Related Content PubMed PubMed Citation Articles by Murakami, S. Articles by Katsumata, T. Related Collections Congestive Valvular heart disease Echocardiography