Imoto N, Honda Y, Hokimoto S, Hamada T, Kuwahara T, Katayama N, Miyauchi Y, Goto H, Kaneko Y
Department of Internal Medicine, Yatsushiro General Hospital.
Kokyu To Junkan. 1992 Jan;40(1):97-101.
A 57-year-old man was admitted with dyspnea and bloody sputum. The chest X-ray showed unilateral alveolar infiltration, and alveolar cell carcinoma was suspected. Physical examination showed orthopnea and a loud systolic murmur, and the echocardiogram showed mitral valve prolapse. A chest X-ray 4 days later revealed bilateral infiltration. The cardiac catheterization showed pulmonary congestion and the capillary wedge pressure revealed a prominent V wave. Papanicolaou's test of sputum was negative. These findings suggested heart failure due to mitral regurgitation rather than lung carcinoma. The patient underwent mitral valve replacement because of his refractoriness to the medical treatment. During the operation, the chordae tendineae of the anterior mitral leaflet was found to be completely ruptured. The mechanisms of unilateral pulmonary edema could not be ascertained, but the effect of posture and gravity was thought to be a possible mechanism.
一名57岁男性因呼吸困难和咯血入院。胸部X线显示单侧肺泡浸润，怀疑为肺泡细胞癌。体格检查显示端坐呼吸和响亮的收缩期杂音，超声心动图显示二尖瓣脱垂。4天后胸部X线显示双侧浸润。心导管检查显示肺充血，毛细血管楔压显示明显的V波。痰涂片巴氏试验阴性。这些发现提示为二尖瓣反流导致的心力衰竭而非肺癌。由于药物治疗效果不佳，患者接受了二尖瓣置换术。手术中发现二尖瓣前叶腱索完全断裂。单侧肺水肿的机制尚不清楚，但体位和重力的作用被认为是一种可能的机制。
