Sakamoto Ayaka, Enomoto Yuki, Watabe Hiroaki, Koyama Yasuaki, Matsumoto Yukei, Shimojo Nobutake, Marushima Aiki, Kawano Satoru, Inoue Yoshiaki
Department of Emergency and Critical Care Medicine University of Tsukuba Hospital Tsukuba Japan.
Acute Med Surg. 2020 Apr 20;7(1):e504. doi: 10.1002/ams2.504. eCollection 2020 Jan-Dec.
Acute mitral regurgitation could occur without common symptoms like hemodynamic instability, but with dyspnea, hemoptysis, and right-sided infiltration on radiography. We report a case of severe alveolar hemorrhage caused by acute mitral regurgitation, which occurred in the absence of shock.
A 40-year-old man presented with dyspnea with bloody phlegm and hypoxia, despite being hemodynamically stable. Chest radiography revealed right-sided infiltration, and bronchoscopy showed fresh bloody phlegm in his tracheae. No specific findings were detected with any tests. After treatment with several medications and support with extracorporeal membrane oxygenation, his condition improved, although the etiology of the disease remained unknown. Transthoracic and transesophageal echocardiogram revealed severe mitral valve regurgitation with ruptured mitral chordae tendineae. These suggested that the sudden onset of mitral valve regurgitation had caused severe alveolar hemorrhage.
Severe alveolar hemorrhage, especially with right-sided infiltration on chest radiography, should be considered a symptom of acute mitral regurgitation.
急性二尖瓣反流可能在没有诸如血流动力学不稳定等常见症状的情况下发生，而是表现为呼吸困难、咯血以及胸部X线检查显示右侧浸润。我们报告一例由急性二尖瓣反流引起的严重肺泡出血病例，该病例发生时并无休克表现。
一名40岁男性，尽管血流动力学稳定，但出现了呼吸困难、咳血痰和低氧血症。胸部X线检查显示右侧浸润，支气管镜检查发现其气管内有新鲜血痰。各项检查均未发现特异性表现。在接受多种药物治疗并辅以体外膜肺氧合支持后，他的病情有所改善，尽管疾病病因仍不明。经胸和经食管超声心动图显示严重二尖瓣反流伴二尖瓣腱索断裂。这些提示二尖瓣反流的突然发作导致了严重肺泡出血。
严重肺泡出血，尤其是胸部X线检查显示右侧浸润时，应考虑为急性二尖瓣反流的一种症状。
