An 80-year-old man with a right upper lobe opacity

The Clinical Respiratory Journal
Hashem BisharaDaniel Weiler-Ravell

Abstract

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. 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. 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. 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.

References

Jul 30, 2003·Thorax·R BootonN Thatcher
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Apr 19, 2007·Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia·Cláudia Maria Cunha RibeiroKlaus Irion
Mar 17, 2010·The American Journal of Geriatric Pharmacotherapy·Horatio B Fung, Maricelle O Monteagudo-Chu
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