Open AccessAn 80‐year‐old man with a right upper lobe opacity
Author(s) -
Bishara Hashem,
Saffuri Amer,
WeilerRavell Daniel
Publication year - 2017
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12293
Subject(s) - medicine , mitral regurgitation , differential diagnosis , radiology , pulmonary edema , etiology , lung , heart failure , mitral valve , cardiology , edema , surgery , pathology
Background and Aims The differential diagnosis of a right upper lobe pulmonary opacity in an elderly afebrile patient includes infectious and malignant etiology. However, unilateral lung edema should also be included in the differential diagnosis. Methods Case report of an 80‐year‐old afebrile patient who presented with cough, dyspnea and blood‐tinged sputum and had an isolated right upper lobe infiltrate on chest X ‐ray on whom a diagnostic work‐up including computed tomography scan of the chest and echocardiography was performed. Results Bilateral alveolar opacities and pleural effusions, not apparent on the chest X ‐ray, and a flail posterior leaflet with severe mitral valve regurgitation were revealed. His symptoms and findings responded to diuretic treatment. Conclusion Pulmonary edema should be considered in a patient with mitral valve regurgitation presenting with a unilateral lung infiltrate. Chest computed tomography scan findings consistent with heart failure and echocardiography demonstrating mitral valve regurgitation are the main clues to the diagnosis. Diuretic therapy should cause a rapid improvement of the radiologic and clinical findings.