Localized Pulmonary Edema After Blunt Chest Trauma
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.
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).
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.
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.