![]() Her chest X-ray revealed alveolar-interstitial infiltrates and a fluid collection around horizontal fissure in her right lung (Fig. ![]() Her limbs examination was normal with normal tone, power, and reflexes.Īn electrocardiogram showed ST depression in leads V5–V6 and poor R wave progression in leads V1–V4. Her cranial nerve examination was normal. Her abdomen was not distended and there was mild right hypochondrial tenderness. Her initial oxygen saturation checked by pulse-oximetry was 56% in room air. Bilateral crepitations and rhonchi were present more significantly on the right side. Her trachea was central and right-sided chest expansion was reduced. There was a pansystolic murmur at cardiac apex. Her blood pressure (BP) was 90/60 mmHg, with a regular, low volume pulse rate of 102 beats per minute. On examination, she was found to be dyspneic, drowsy, pale, diaphoretic, and restless. At presentation she was on captopril 12.5 mg twice a day, atorvastatin 20 mg at night, soluble aspirin 75 mg at night, bisoprolol 2.5 mg once a day, and furosemide 40 mg in the morning. She does not smoke tobacco or drink alcohol. She is a housewife and mother of five children. Apart from her usual symptoms she did not have fever, cough, or chest pain before admission. She could walk 25 meters and could climb 3–4 steps without becoming dyspneic. She had a New York Heart Association (NYHA) heart failure grade of class 2, and could manage her day-to-day activities without support. She had eaten her dinner and taken her usual medications before sleeping. Even in the absence of readily available echocardiogram skills, a clinical examination is of paramount importance in making a clinical decision in low-resource settings to reduce mortality.Īn 86-year-old Sinhalese Sri Lankan woman who had been previously diagnosed as having hypertension, grade 2 MR, and ischemic heart disease with congestive cardiac failure, presented to our preliminary care unit with sudden onset shortness of breath at night while sleeping. ![]() Unilateral pulmonary edema is a completely reversible condition with good patient outcome if it is suspected early and treated early. Her brain natriuretic peptide level was elevated and further supported and confirmed the diagnosis retrospectively. She had remarkable clinical and radiological improvement after 12 hours of intravenously administered furosemide and glyceryl trinitrate therapy. ![]() Distinguishing pneumonia from pulmonary edema according to chest X-ray findings was a challenge initially, and she was therefore initially treated for both conditions. She had clinical features of heart failure and pulmonary edema, but a chest X-ray showed unilateral infiltrates only on the right side. We present a case of right-sided unilateral pulmonary edema in an 86-year-old Sinhalese Sri Lankan woman who presented with acute onset dyspnea with cardiogenic shock due to acute non-ST elevation myocardial infarction, complicated with grade 3 mitral regurgitation. Due to its rare presentation, a high index of suspicion is required, and correct management is necessary to reduce the morbidity and mortality. There are many causes of unilateral pulmonary edema, but the commonest is the presence of a grade 3 mitral regurgitation. In a majority of patients it occurs in the upper lobe of the right lung. Unilateral pulmonary edema is an uncommon condition and is a rare clinical entity that is often misdiagnosed at the initial stages.
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