Unilateral pulmonary oedema secondary to anterior mitral valve leaflet prolapse

Abstract

Cardiogenic unilateral pulmonary oedema (UPE) is an uncommon clinical condition which is often mistaken for lower respiratory tract infection (LRTI). It is typically caused by asymmetric systolic flow reversal in the right pulmonary veins due to severe mitral valve regurgitation (MR). We describe the case of a 41-year-old woman with a history of undifferentiated chronic mixed connective tissue disease, Raynaud’s disease and pituitary adenoma who presented with acute shortness of breath (SOB), chest tightness, orthopnoea and paroxysmal nocturnal dyspnoea. A computerized tomography pulmonary angiogram (CTPA) showed signs consistent with pulmonary oedema secondary to congestive heart failure. This prompted urgent echocardiography which revealed a flail and prolapsing A2 leaflet of the mitral valve with a posteriorly-directed MR jet, resulting in systolic flow reversal in the pulmonary veins which is consistent with severe MR. The patient underwent an urgent mitral valve (MV) replacement and optimization of medical therapy, resulting in clinical and radiographic improvement.