全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation

DOI: 10.1155/2013/179587

Full-Text   Cite this paper   Add to My Lib

Abstract:

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 [4–8]. However, acute mitral regurgitation (MR) has rarely been reported as an etiology for DAH [9–13]. Cardiac etiologies of DAH seem to act through mechanical pressure rather than by inflammation of the

References

[1]  U. Specks, “Diffuse alveolar hemorrhage syndromes,” Current Opinion in Rheumatology, vol. 13, no. 1, pp. 12–17, 2001.
[2]  J. J. Alarcon, P. Guembe, E. de Miguel, I. Gordillo, and A. Abellas, “Localized right upper lobe edema,” Chest, vol. 107, no. 1, pp. 274–276, 1995.
[3]  P. A. Schnyder, A. M. Sarraj, B. E. Duvoisin, L. Kapenberger, and M. J.-M. Landry, “Pulmonary edema associated with mitral regurgitation: prevalence of predominant involvement of the right upper lobe,” The American Journal of Roentgenology, vol. 161, no. 1, pp. 33–36, 1993.
[4]  G. Bonan, I. Caubarrere, and H. Beaufils, “Diffuse alveolar haemorrhage and severe glomerulonephritis induced by D. Penicillamine: a case report and review,” Therapie, vol. 41, no. 4, pp. 297–298, 1986.
[5]  R. J. Murray, R. J. Albin, W. Mergner, and G. J. Criner, “Diffuse alveolar hemorrhage temporally related to cocaine smoking,” Chest, vol. 93, no. 2, pp. 427–429, 1988.
[6]  C. P. Marak, N. Alappan, C. Shim, and A. K. Guddati, “Diffuse alveolar hemorrhage due to ketorolac tromethamine,” Pharmacology, vol. 92, no. 1-2, pp. 11–13, 2013.
[7]  H. W. Ramsey, A. de la Torre, T. D. Bartley, and J. W. Linhart, “Intractable hemoptysis in mitral stenosis treated by emergency mitral commissurotomy,” Annals of Internal Medicine, vol. 67, no. 3, pp. 588–593, 1967.
[8]  O. C. Ioachimescu and J. K. Stoller, “Diffuse alveolar hemorrhage: diagnosing it and finding the cause,” Cleveland Clinic Journal of Medicine, vol. 75, no. 4, pp. 258–280, 2008.
[9]  Case records of the Massachusetts General Hospital, “Weekly clinicopathological exercises. Case 17-1995. An 81-year-old woman with mitral regurgitation and a left-upper-lobe pulmonary infiltrate,” The New England Journal of Medicine, vol. 332, no. 23, pp. 1566–1572, 1995.
[10]  T. H. Spence and J. C. Connors, “Diffuse alveolar hemorrhage syndrome due to “silent” mitral valve regurgitation,” Southern Medical Journal, vol. 93, no. 1, pp. 65–67, 2000.
[11]  K. Woolley and P. Stark, “Pulmonary parenchymal manifestations of mitral valve disease,” Radiographics, vol. 19, no. 4, pp. 965–972, 1999.
[12]  A. W.-T. Yeung, H. P. Shum, G. S.-M. Lam, K. K.-C. Chan, S. K. Li, and W. W. Yan, “Diffuse alveolar hemorrhage and intravascular hemolysis due to acute mitral valve regurgitation,” Critical Care and Shock, vol. 16, no. 1, pp. 3–7, 2013.
[13]  U. Kim HG, D. H. Kim, S. H. Lee et al., “Diffuse alveolar hemorrhage due to acute mitral regurgitation,” Journal of Cardiovascular Ultrasound, vol. 15, no. 1, pp. 16–18, 2007.
[14]  S. K. Sharma, J. Seckler, D. H. Israel, S. Borrico, and J. A. Ambrose, “Clinical, angiographic and anatomic findings in acute severe ischemic mitral regurgitation,” The American Journal of Cardiology, vol. 70, no. 3, pp. 277–280, 1992.
[15]  J. M. Roach, K. C. Stajduhar, and K. G. Torrington, “Right upper lobe pulmonary edema caused by acute mitral regurgitation: diagnosis by transesophageal echocardiography,” Chest, vol. 103, no. 4, pp. 1286–1288, 1993.
[16]  M. Schlueter, B. A. Langenstein, and P. Hanrath, “Assessment of transesophageal pulsed Doppler echocardiography in the detection of mitral regurgitation,” Circulation, vol. 66, no. 4, pp. 784–789, 1982.
[17]  M. D. Smith, M. R. Harrison, R. Pinton, H. Kandil, O. L. Kwan, and A. N. DeMaria, “Regurgitant jet size by transesophageal compared with transthoracic Doppler color flow imaging,” Circulation, vol. 83, no. 1, pp. 79–86, 1991.
[18]  K. K. Stout and E. D. Verrier, “Acute valvular regurgitation,” Circulation, vol. 119, no. 25, pp. 3232–3241, 2009.
[19]  R. E. Steiner and J. F. Goodwin, “Some observations on mitral valve disease,” Journal of The Faculty of Radiologists, vol. 5, no. 3, pp. 167–177, 1954.
[20]  R. W. Galloway, E. J. Epstein, and N. Coulshed, “Pulmonary ossific nodules in mitral value disease,” British Heart Journal, vol. 23, pp. 297–307, 1961.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133