Usually, left-sided cardiac pathology causes bilateral pulmonary edema but still, the unilateral pattern is seen in a fair number of cases, usually involving right lung parenchyma.
Likely mechanisms include:
1) Lymphatic drainage on the right side is via low caliber right bronchomediastinal trunk as opposed to the more robust thoracic duct on the left side.
2) Numerous conditions ranging from hypertension to valvular pathology can cause enlargement of the left side of the heart.
This will preferentially impinge on the left pulmonary artery causing reduced capillary perfusion and ultimately congestion of left lung parenchyma.
3) In cases of mitral regurgitation jet of regurgitating can preferentially impact either of the right or left pulmonary veins, hence explaining more profound edema on either side.
So, if according to the patient's history and clinical examination suspicion of cardiac failure remains high, then immediate intervention with diuretics and nitrates is warranted in spite of a unilateral pattern of pulmonary edema.
Kirtan Patolia
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