Sunday, December 2, 2018

Peculiar pattern of pulmonary edema

Usually left sided cardiac pathology causes bilateral pulmonary edema but still unilateral pattern is seen in fair number of cases, usually involving right lung parenchyma.

Likely mechanisms include:

1) Lymphatic drainage on right side is via low calibre right bronchomediastinal trunk as opposed to more robust thoracic duct on left side.

2) Numerous conditions ranging from hypertension to valvular pathology can cause enlargement of left side of heart.
This will preferentially impinge on left pulmonary artery causing reduced capillary perfusion and ultimately congestion of left lung parenchyma.

3) In cases of mitral regurgitation jet of regurgitate can preferentially impact either of the right or left pulmonary veins, hence explaining more profound edema on either side.

So, if according to patient's history and clinical examination suspicion of cardiac failure remains high, then immediate intervention with diuretics and nitrates is warranted in spite of unilateral pattern of pulmonary edema.

Kirtan Patolia

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