%0 Journal Article
%T Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation
%A Creticus P. Marak
%A Parijat S. Joy
%A Pragya Gupta
%A Yana Bukovskaya
%A Achuta K. Guddati
%J Case Reports in Pulmonology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/179587
%X Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH. 1. Introduction Hemoptysis can be caused by lesions that are localized in the airway, lungs or by widespread lesions in the lungs. Diffuse alveolar hemorrhage (DAH) is characterized by widespread bleeding into the alveoli due to microvascular injury [1]. DAH may also be accompanied by pulmonary edema. The resultant impediment of gas exchange is thought to cause dyspnea. Whereas most patients present with bilateral involvement, unilateral involvement is rare. Cardiogenic unilateral pulmonary edema is a rare clinical entity that presents with diagnostic challenges. Most cases occur in the upper right side and are caused by severe mitral regurgitation [2, 3]. It is associated with an independent increased risk of mortality due to possible delay in diagnosis and underestimation of the severity of mitral regurgitation (MR). Cardiogenic unilateral pulmonary edema is more common on the right side for several reasons. The direction of the mitral regurgitation jet predominantly affects the upper right pulmonary vein and causes a larger increase in mean capillary pressure on the right side. This may consequently result in a greater degree of right acute pulmonary edema. Patients with DAH usually present with dyspnea and diffuse alveolar infiltrates noted on imaging. Many etiologies such as drug exposure (penicillamine, propylthiouracil, ketorolac, etc.), cocaine smoking, pulmonary embolism, sarcoidosis, vasculitis, and mitral stenosis have been documented to cause DAH [4¨C8]. However, acute mitral regurgitation (MR) has rarely been reported as an etiology for DAH [9¨C13]. Cardiac etiologies of DAH seem to act through mechanical pressure rather than by inflammation of the
%U http://www.hindawi.com/journals/cripu/2013/179587/