Hein Aung, Wai Yin H
Department of Cardiology, University Hospitals Dorset NHS Foundation Trust, Bournemouth, GBR.
Department of Respiratory Medicine, Poole General Hospital, Poole, GBR.
Cureus. 2022 Dec 9;14(12):e32347. doi: 10.7759/cureus.32347. eCollection 2022 Dec.
Pulmonary oedema of uncertain aetiology is a diagnostic challenge to clinicians worldwide. Many indicators are proposed to differentiate between cardiogenic and non-cardiogenic pulmonary oedema. Mixed pulmonary oedema is an overlap between high hydrostatic pressure and increased permeability at the microvascular level. In our case, a 77-year-old patient presented with a nine-day history of shortness of breath. He was hypoxemic in the emergency department, had a pan-systolic murmur on auscultation, and blood results showed raised inflammatory markers without any fever. His chest X-ray and computed tomography pulmonary angiogram showed asymmetric pulmonary oedema in bilateral superior lobes and bilateral pleural effusions. Point-of-care echocardiography revealed severe mitral regurgitation. Trans-oesophageal echocardiography confirmed mitral valve prolapse with the chordae rupture and systolic vein reversal flow seen in the right superior pulmonary vein. He was treated with antibiotics and diuretics. After starting intravenous diuretics, there was a rapid symptomatic improvement, and a repeat chest X-ray showed significant improvements. We concluded that it was a case of mixed pulmonary oedema with predominant cardiac aetiology, and he was referred to cardiothoracic surgery for mitral valve replacement. The case showed that mixed pulmonary oedema with atypical chest radiography appearances would be a diagnostic challenge for clinicians. In such presentations, both cardiogenic and non-cariogenic causes of pulmonary oedema should be considered.
病因不明的肺水肿对全球临床医生来说都是一项诊断挑战。人们提出了许多指标来区分心源性和非心源性肺水肿。混合性肺水肿是微血管水平高静水压和通透性增加之间的一种重叠情况。在我们的病例中，一名77岁患者有9天的气短病史。他在急诊科时低氧血症，听诊有全收缩期杂音，血液检查结果显示炎症标志物升高但无发热。他的胸部X线和计算机断层扫描肺动脉造影显示双侧上叶不对称肺水肿及双侧胸腔积液。床旁超声心动图显示严重二尖瓣反流。经食管超声心动图证实二尖瓣脱垂伴腱索断裂，右上肺静脉可见收缩期血流逆转。他接受了抗生素和利尿剂治疗。开始静脉注射利尿剂后，症状迅速改善，复查胸部X线显示有显著改善。我们得出结论，这是一例以心脏病因为主的混合性肺水肿病例，他被转诊至心胸外科进行二尖瓣置换术。该病例表明，具有非典型胸部X线表现的混合性肺水肿对临床医生来说是一项诊断挑战。在这种情况下，应同时考虑肺水肿的心源性和非心源性病因。
