Acute Mitral Regurgitation With Unilateral Pulmonary Edema: Preferential Pulmonary Venous Loading From an Eccentric Jet.

BACKGROUND

Acute severe mitral regurgitation (MR) can cause rapidly progressive asymmetric pulmonary edema that mimics pneumonia.

CASE SUMMARY: A 22-year-old man presented with fever, dyspnea, and a new pansystolic murmur. Within hours, he developed hypoxemic respiratory failure. Serial chest imaging captured rapid progression from subtle right hilar vascular prominence to extensive right-predominant airspace opacification. Echocardiography showed posterior leaflet chordal rupture with a flail P2 segment and a severe eccentric MR jet directed toward the right pulmonary venous inflow, with systolic flow reversal in a sampled right pulmonary vein. Mitral valve repair produced marked clinical and radiographic improvement.

DISCUSSION: Concordance among the MR jet trajectory, pulmonary venous abnormalities, and edema distribution supported preferential right pulmonary venous loading. Recognition of this pattern helped distinguish asymmetric cardiogenic pulmonary edema from pneumonia.

TAKE-HOME MESSAGE: Rapidly evolving focal pulmonary opacification with a new systolic murmur should prompt urgent echocardiography.