Asymetric pulmonary edema due to left anterior descending artery occlusion
Presentation
Shortness of breath.
Patient Data
pCXR at presentation
Right-sided air space disease, left lung clear.
CT at presentation
Diffuse ground glass opacity in the right lung, bilateral increased septal lines, with the right side worse than the left.
Cath after admission
Normal left main and circumflex coronary arteries, complete occlusion left anterior descending artery just distal to it's origin. Left ventriculogram shows apical hypokinesis.
pCXR 4 days after admission
Endotracheal tube, nasogastric tube and temporary pacemaker appropriately positioned. "Bat-wing" pulmonary edema pattern.
Case Discussion
This patient presented with asymmetric cardiogenic pulmonary edema (right >> left) following occlusion of the left anterior descending artery. Asymmetric or unilateral edema is uncommon but should suggest mitral valve regurgitation, with preferential retrograde flow of blood back into the right pulmonary veins.
Characteristically, though not in this case, the right upper lobe is most severely involved. In this patient, the occluded LAD may have resulted in ischemia of the anterolateral papillary muscle with subsequent mitral regurgitation.
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