Schnyder P A, Sarraj A M, Duvoisin B E, Kapenberger L, Landry M J
Department of Radiology, University Hospital (Centre Hospitalier Universitaire Vaudois), Lausanne, Switzerland.
AJR Am J Roentgenol. 1993 Jul;161(1):33-6. doi: 10.2214/ajr.161.1.8517316.
The symmetric distribution of pulmonary vascular congestion and edema caused by left ventricular heart failure associated with severe mitral regurgitation as seen on chest radiographs is well known. To our knowledge, only eight cases have been reported in which congestion and edema were confined to one lung or a portion of one lung. The purpose of this study was to determine the prevalence of asymmetric findings in these patients.
Three radiologists retrospectively and independently reviewed the plain chest radiographs of 131 patients with severe mitral regurgitation admitted to our institution during a 3-year period. Radiographs showing asymmetric vascular congestion or pulmonary edema were identified. Clinical records of these patients were studied to exclude other causes of pulmonary disease.
Radiographic signs of vascular congestion and edema were present in 117 (89%) of the 131 patients. In 12 (9%) of 131 patients, these findings were localized or predominant in the upper lobe of the right lung. None of the patients had predominantly left-sided involvement.
Pulmonary vascular congestion and edema involving predominantly the upper lobe of the right lung in patients with severe mitral regurgitation occurs more frequently than previously thought. This information is useful in the differential diagnosis of right upper lobe abnormalities, such as pneumonia.
胸部X线片上左心室心力衰竭合并严重二尖瓣反流所致的肺血管充血和水肿的对称分布是众所周知的。据我们所知，仅有8例报告显示充血和水肿局限于一侧肺或一侧肺的一部分。本研究的目的是确定这些患者中不对称表现的发生率。
三位放射科医生对我院3年内收治的131例严重二尖瓣反流患者的胸部平片进行回顾性独立阅片。识别出显示不对称血管充血或肺水肿的X线片。研究这些患者的临床记录以排除其他肺部疾病原因。
131例患者中有117例（89%）出现血管充血和水肿的影像学表现。131例患者中有12例（9%）这些表现局限于或主要位于右肺上叶。没有患者主要累及左肺。
严重二尖瓣反流患者中主要累及右肺上叶的肺血管充血和水肿比以前认为的更常见。该信息对右上叶异常（如肺炎）的鉴别诊断有用。
